CHAA CHAA Insurance Verification and Eligibility 4

Question 1

A 67-year-old patient is still working full-time and covered by an employer group health plan from a company with 50 employees. Which payer is primary?

Accepted Answer

The employer group health plan

Answer

For working-aged beneficiaries 65+ covered through current employment at an employer with 20 or more employees, the group health plan is primary to Medicare.

Question 2

A patient with end-stage renal disease has both an employer group health plan and Medicare. During the 30-month coordination period, which plan pays first?

Accepted Answer

The employer group health plan

Answer

During the ESRD 30-month coordination period, the group health plan is primary and Medicare is secondary.

Question 3

For a Medicare patient receiving recurring outpatient therapy services, how often should the Medicare Secondary Payer (MSP) questionnaire information be re-verified?

Accepted Answer

Every 90 days

Answer

CMS allows recurring outpatient MSP information to be verified once every 90 days.

Question 4

A patient's allowed amount is $1,000, they have $200 of deductible remaining, and their plan pays 80% after the deductible. What is the patient's responsibility?

Accepted Answer

$360

Answer

The patient pays the $200 deductible plus 20% of the remaining $800 ($160), totaling $360.

Question 5

A child's divorced parents both carry health insurance, and there is no court decree assigning responsibility. Which plan is typically primary?

Accepted Answer

The custodial parent's plan

Answer

Absent a court order, NAIC coordination rules make the custodial parent's plan primary for dependents of divorced or separated parents.

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Practice Test

CHAA CHAA Insurance Verification and Eligibility 4