CHAA Financial Processes 2 — Questions and Answers
Question 1: A patient's insurance plan has a $2,000 deductible and they have met $1,500. What should the access associate communicate about a $800 procedure?
- The patient owes nothing because they have insurance
- The patient may owe approximately $500 toward the deductible plus any applicable coinsurance (Correct answer)
- The patient must pay the full $800 upfront
- Financial discussions should wait until after the procedure
Correct answer: The patient may owe approximately $500 toward the deductible plus any applicable coinsurance
With $500 remaining on the deductible, the patient would owe that amount plus any coinsurance on the remaining $300, depending on plan terms.
Understanding deductible math is essential for accurate patient estimates. The patient has $500 remaining on their deductible ($2,000 - $1,500). Of the $800 procedure, $500 applies to the deductible. The remaining $300 would be subject to the plan's coinsurance rate. Communicating this clearly helps patients prepare financially and reduces surprise bills.
Question 2: What is the primary purpose of collecting point-of-service (POS) payments?
- To generate revenue before insurance processes the claim
- To reduce accounts receivable days and improve cash flow (Correct answer)
- To penalize patients for seeking medical care
- To verify the patient's identity
Correct answer: To reduce accounts receivable days and improve cash flow
POS collections reduce the accounts receivable cycle, improve cash flow, and decrease the cost of post-service collection efforts.
Studies show that collecting at the point of service costs approximately $8 per transaction compared to $25-50 for post-service billing and collections. POS collections improve days in A/R, reduce bad debt write-offs, and provide predictable cash flow. Patient access is the front line of revenue cycle management, making POS collection a critical function.
Question 3: A patient qualifies for charity care but also has Medicaid. How should this be handled?
- Apply charity care first since it covers more
- Bill Medicaid first as the primary payer, then apply charity care to remaining balance if applicable (Correct answer)
- Let the patient choose which program to use
- Deny charity care since they have Medicaid
Correct answer: Bill Medicaid first as the primary payer, then apply charity care to remaining balance if applicable
Insurance must always be billed as the primary payer before applying charity care or financial assistance to any remaining patient responsibility.
Federal and state regulations require that all insurance coverage be exhausted before applying financial assistance programs. Medicaid, as active insurance, must be billed first. Charity care policies typically apply only to the patient's remaining responsibility after all payers have processed. This protects both the patient and the facility's compliance with payer contracts.
Question 4: What does 'timely filing' refer to in the context of healthcare billing?
- Filing patient charts within 24 hours of discharge
- Submitting insurance claims within the payer's deadline to avoid denial (Correct answer)
- Completing patient registration before the appointment time
- Filing tax documents for the healthcare organization
Correct answer: Submitting insurance claims within the payer's deadline to avoid denial
Timely filing refers to the deadline by which claims must be submitted to an insurance payer, typically ranging from 90 days to one year depending on the payer.
Each payer sets timely filing limits in their provider contracts. Medicare requires claims within 12 months, while commercial payers may require 90-180 days. Missing these deadlines results in automatic denial with no appeal rights. Patient access contributes to timely filing by ensuring accurate registration data from the start, preventing rework that delays claim submission.
Question 5: Which document is required before providing a patient with a good faith estimate under the No Surprises Act?
- A signed consent to treat
- A scheduled service or a patient request for an estimate (Correct answer)
- A referral from the primary care physician
- Pre-authorization from the insurance company
Correct answer: A scheduled service or a patient request for an estimate
Under the No Surprises Act, facilities must provide good faith estimates to uninsured or self-pay patients upon scheduling or upon request.
The No Surprises Act requires healthcare providers to give uninsured or self-pay patients a good faith estimate of expected charges. This is triggered when a service is scheduled or when the patient requests an estimate. The estimate must be provided within specified timeframes (1-3 business days depending on when the service is scheduled) and must include all expected charges from all providers involved.
Question 6: What is a 'clean claim' in healthcare billing?
- A claim that has been sanitized of patient identifiers
- A claim submitted with all required data elements and no errors (Correct answer)
- A claim that was paid on first submission regardless of accuracy
- A claim with no associated patient balance
Correct answer: A claim submitted with all required data elements and no errors
A clean claim contains all required fields, correct codes, and accurate patient/insurance information, allowing processing without additional development.
Clean claims are defined by CMS as claims that can be processed without obtaining additional information from the provider. They include correct patient demographics, valid insurance information, proper diagnosis and procedure codes, and required modifiers. Patient access directly impacts clean claim rates through accurate registration and insurance verification.
CHAA Financial Processes 2
A patient's insurance plan has a $2,000 deductible and they have met $1,500.
What should the access associate communicate about a $800 procedure?