PAR Financial Clearance and Counseling 2 — Questions and Answers
Question 1: 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?
- $700 (Correct answer)
- $1,800
- $2,500
- $4,300
Correct answer: $700
The remaining deductible is $2,500 minus $1,800 already met, which equals $700.
Question 2: Which federal program provides health coverage for patients aged 65 and older as well as certain disabled individuals?
- Medicaid
- CHIP
- Medicare (Correct answer)
- TRICARE
Correct answer: Medicare
Medicare is the federal health insurance program primarily for individuals 65 and older and qualifying disabled persons.
Question 3: When a patient presents with two active insurance policies, which policy is typically billed first?
- The policy with the higher deductible
- The secondary insurance
- The primary insurance (Correct answer)
- The policy covering the most services
Correct answer: The primary insurance
Coordination of benefits rules require that the primary insurance is billed first before any secondary payer is billed.
Question 4: A Patient Access Representative is reviewing an authorization and notices it expired yesterday. What is the correct next step?
- Proceed with service since it was valid recently
- Contact the payer to obtain a new or extended authorization (Correct answer)
- Ask the patient to self-pay for the visit
- Cancel the appointment without notifying the patient
Correct 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.
Question 5: Which of the following best describes a 'coinsurance' obligation?
- A fixed dollar amount paid per visit
- The annual maximum a patient pays out-of-pocket
- A percentage of the allowed amount the patient pays after meeting the deductible (Correct answer)
- The premium a patient pays monthly for coverage
Correct 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.
Question 6: A self-pay patient is unable to pay a $4,000 hospital bill. Which financial assistance option should the PAR explore first?
- Send the account directly to collections
- Check eligibility for the facility's charity care or financial assistance program (Correct answer)
- Require a co-signer before treatment
- Reduce the bill arbitrarily by 50%
Correct 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.
Question 7: What is the primary purpose of obtaining a pre-certification before an elective inpatient procedure?
- To collect the patient's copay in advance
- To verify that the payer approves the medical necessity of the planned service (Correct answer)
- To schedule the patient's discharge date
- To confirm the physician's credentials
Correct 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.
PAR Financial Clearance and Counseling 2
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?