Financial Clearance and Counseling Flashcards

A patient has a $2,500 deductible and has already met $1,800 of it. How much of the deductible remains before insurance begins paying?

Answer: $700

The remaining deductible is $2,500 minus $1,800 already met, which equals $700.

Which federal program provides health coverage for patients aged 65 and older as well as certain disabled individuals?

Answer: Medicare

Medicare is the federal health insurance program primarily for individuals 65 and older and qualifying disabled persons.

When a patient presents with two active insurance policies, which policy is typically billed first?

Answer: The primary insurance

Coordination of benefits rules require that the primary insurance is billed first before any secondary payer is billed.

A Patient Access Representative is reviewing an authorization and notices it expired yesterday. What is the correct next step?

Answer: Contact the payer to obtain a new or extended authorization

An expired authorization is not valid; the PAR must contact the payer to secure a current authorization before providing non-emergency services.

Which of the following best describes a 'coinsurance' obligation?

Answer: A percentage of the allowed amount the patient pays after meeting the deductible

Coinsurance is the patient's percentage share of costs (e.g., 20%) after the deductible has been satisfied.

A self-pay patient is unable to pay a $4,000 hospital bill. Which financial assistance option should the PAR explore first?

Answer: Check eligibility for the facility's charity care or financial assistance program

Most hospitals have charity care or financial assistance programs that should be evaluated before collections or other measures.

What is the primary purpose of obtaining a pre-certification before an elective inpatient procedure?

Answer: To verify that the payer approves the medical necessity of the planned service

Pre-certification confirms that the insurance payer considers the proposed procedure medically necessary and agrees to cover it.