PAR Denial Management and Point of Service Collections Flashcards

What is 'point of service (POS) collection' in patient access?

Answer: Collecting patient cost-sharing amounts such as copays, deductibles, and coinsurance at the time of the visit rather than billing after service

POS collection means collecting the patient's financial obligation—copay, estimated deductible, or coinsurance—at or before the time of service to improve cash flow and reduce bad debt.

What is a 'self-pay patient' in healthcare revenue cycle?

Answer: A patient who has no insurance coverage and is personally responsible for the full cost of their care

A self-pay patient has no insurance and is directly responsible for payment, and patient access staff should screen them for financial assistance programs and provide cost estimates.

What is 'charity care' (financial assistance program) in a hospital setting?

Answer: A program that provides free or discounted services to patients who meet income eligibility criteria and cannot afford to pay for their care

Charity care programs reduce or eliminate patient balances for individuals below income thresholds (typically based on federal poverty level), and nonprofit hospitals are required to have such policies.

What is 'bad debt' in healthcare revenue cycle management?

Answer: Accounts receivable written off as uncollectible after reasonable collection efforts have been exhausted on patients who had the ability to pay but did not

Bad debt represents balances from patients who were expected to pay but did not, distinguishing it from charity care where patients lacked the means to pay.

What is the purpose of a 'payment plan' offered by patient access representatives?

Answer: To allow patients to pay their balance in scheduled installments over time rather than in a single lump sum, reducing defaults and bad debt

Payment plans break a patient's balance into manageable monthly installments, increasing the likelihood of full collection while improving patient satisfaction and reducing bad debt write-offs.

What does 'charity care screening' involve during a patient access encounter?

Answer: Gathering income and household size information to determine if a patient qualifies for free or reduced-cost care under the hospital's financial assistance policy

Charity care screening involves collecting financial information such as income, household size, and assets to evaluate eligibility against the hospital's financial assistance criteria based on federal poverty guidelines.