CHAA Financial Processes 5

Question 1

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?

Accepted Answer

The $40 copay

Answer

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

Question 2

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?

Accepted Answer

The patient may initiate the patient-provider dispute resolution process

Answer

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

Question 3

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?

Accepted Answer

Presumptive eligibility

Answer

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

Question 4

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

Accepted Answer

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

Answer

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

Question 5

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?

Accepted Answer

Obtain the authorization or reschedule before the service

Answer

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

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Practice Test

CHAA Financial Processes 5