PAR - Patient Access Representative Revenue Cycle Fundamentals Questions and Answers

Question 1

A claim is denied with the reason 'Subscriber and Patient Not a Match.' Which of the following errors during the patient access process is the most likely cause?

Accepted Answer

Transposing digits in the subscriber's policy number during data entry.

Answer

Failing to obtain prior authorization for the service.

Answer

Not collecting the patient's co-pay amount at the time of service.

Answer

Incorrectly entering the patient's primary diagnosis code.

Question 2

A Patient Access Representative is registering a Medicare patient for a lab test. The system's medical necessity check indicates the test may not be covered for the provided diagnosis. What is the most appropriate action?

Accepted Answer

Inform the patient of potential non-coverage and have them sign an Advance Beneficiary Notice of Noncoverage (ABN).

Answer

Cancel the appointment and tell the patient to reschedule with a different diagnosis.

Answer

Bill the service to Medicare, as the system may be incorrect.

Answer

Proceed with the test but mark the claim as a provider liability.

Question 3

A new patient with an HMO insurance plan calls to schedule an appointment with a specialist. The patient has not yet seen their primary care provider (PCP) for the current medical issue. What must the representative confirm is in place before scheduling the specialist visit?

Accepted Answer

A referral from the patient's Primary Care Physician (PCP).

Answer

That the patient's annual deductible has been met.

Answer

The specialist's National Provider Identifier (NPI) number.

Answer

That the patient has signed a consent to treat form.

Question 4

After a claim is adjudicated, the payer sends a document to the healthcare provider detailing the payment, adjustments, and final amount owed by the patient. What is this document called?

Accepted Answer

A Remittance Advice (RA)

Answer

A Superbill

Answer

A UB-04 Claim Form

Answer

An Explanation of Benefits (EOB)

Question 5

A patient's adult child, who is not listed as an authorized contact, calls the registration desk asking for specific details about their parent's diagnosis. According to HIPAA's Minimum Necessary Rule, what information can the Patient Access Representative provide?

Accepted Answer

No protected health information (PHI) without the patient's explicit authorization.

Answer

The name of the attending physician.

Answer

The general status of the patient, such as 'stable'.

Answer

The date and time of the patient's procedure.

Question 6

Which of the following is the most significant risk associated with creating a duplicate medical record in the Master Patient Index (MPI)?

Accepted Answer

It can negatively impact patient safety due to a fragmented health history.

Answer

It increases the data storage costs for the hospital's IT department.

Answer

It makes scheduling future appointments slightly more complicated.

Answer

It can cause minor delays in billing and claim submission.