Financial Processes Flashcards

A patient with a $40 copay and an unmet deductible comes for an office visit covered under the copay benefit. What is typically collected at check-in?

Answer: The $40 copay

When a service falls under the copay benefit, the fixed copay is collected at the time of service.

An uninsured patient's Good Faith Estimate was $1,000, but the final bill is $1,500. What option does the No Surprises Act provide?

Answer: The patient may initiate the patient-provider dispute resolution process

If the bill exceeds the Good Faith Estimate by $400 or more, the self-pay patient may use the patient-provider dispute resolution process.

A hospital uses third-party data (such as credit or demographic scoring) to qualify a patient for charity care without a full application. What is this called?

Answer: Presumptive eligibility

Presumptive eligibility uses outside data or enrollment in means-tested programs to grant financial assistance without a complete application.

Which account would most appropriately be classified as charity care rather than bad debt?

Answer: A patient who qualified under the financial assistance policy before collection efforts

Charity care applies to patients determined eligible for assistance, while bad debt results from unwillingness to pay after collection efforts.

A patient presents an expensive elective procedure order with a prior authorization requirement that has not been obtained. What is the best financial clearance step?

Answer: Obtain the authorization or reschedule before the service

Securing required prior authorization before elective services prevents avoidable denials and patient liability disputes.

At end of shift, a registrar's cash drawer is $20 short against the posted payments report. What should be done?

Answer: Report the variance to a supervisor and document it per cash-handling policy

Cash variances must be documented and reported to maintain internal controls and audit trails.

Federal hospital price transparency rules require hospitals to post which of the following?

Answer: A machine-readable file of standard charges and a consumer-friendly list of shoppable services

CMS requires a comprehensive machine-readable file of standard charges and at least 300 shoppable services in a consumer-friendly format (or a price estimator tool).