CHAA CHAA Patient Financial Counseling and Collections 1 — Questions and Answers
Question 1: What is the primary purpose of a financial counselor in the patient access department?
- To process insurance claims
- To help patients understand their financial obligations and explore payment options (Correct answer)
- To verify insurance eligibility
- To schedule patient appointments
Correct answer: To help patients understand their financial obligations and explore payment options
Financial counselors educate patients about their estimated costs and assist them in identifying payment options such as payment plans, charity care, or financial assistance programs.
Question 2: Which federal program provides financial assistance to low-income patients who do not qualify for Medicaid?
- CHIP
- COBRA
- Charity care / hospital financial assistance programs (Correct answer)
- Medicare Advantage
Correct answer: Charity care / hospital financial assistance programs
Hospitals are required under the ACA to have financial assistance (charity care) policies to help low-income patients who do not qualify for government programs like Medicaid.
Question 3: A patient's out-of-pocket maximum has been met for the year. What does this mean for subsequent covered services?
- The patient owes 100% of costs
- The insurance company pays 100% of covered costs for the remainder of the benefit year (Correct answer)
- The patient's deductible resets immediately
- The patient must switch to a different plan
Correct answer: The insurance company pays 100% of covered costs for the remainder of the benefit year
Once a patient reaches their out-of-pocket maximum, the insurer covers 100% of all covered in-network services for the rest of the plan year.
Question 4: What is a sliding fee scale used for in patient financial counseling?
- Calculating insurance premiums
- Adjusting patient charges based on income and family size (Correct answer)
- Determining Medicare reimbursement rates
- Setting copay amounts for all patients
Correct answer: Adjusting patient charges based on income and family size
A sliding fee scale reduces patient charges proportionally based on household income and family size, making care more accessible to lower-income patients.
Question 5: Which document must a patient sign to authorize the release of billing information to their insurance company?
- Advance Directive
- Assignment of Benefits (AOB) (Correct answer)
- HIPAA Notice of Privacy Practices
- Consent to Treat
Correct answer: Assignment of Benefits (AOB)
An Assignment of Benefits authorizes the provider to bill the insurance company directly and allows the insurer to pay the provider rather than the patient.
Question 6: What is the correct approach when a patient states they cannot afford their estimated balance prior to service?
- Deny service immediately
- Refer the patient to financial counseling and screen for assistance programs before service (Correct answer)
- Require full payment upfront
- Reduce all charges by 50% without documentation
Correct answer: Refer the patient to financial counseling and screen for assistance programs before service
Patients should be screened for financial assistance eligibility and counseled on available options prior to service rather than denied care based on inability to pay.
CHAA CHAA Patient Financial Counseling and Collections 1
What is the primary purpose of a financial counselor in the patient access department?