PAR Financial Clearance and Counseling 3

Question 1

Under the Affordable Care Act, what is the term for the annual cap on how much a patient must pay out-of-pocket for covered services?

Accepted Answer

Out-of-pocket maximum

Answer

The out-of-pocket maximum is the ACA-mandated limit on total annual cost-sharing (deductibles, copays, coinsurance) a patient owes.

Question 2

A patient's insurance card shows 'HMO.' What referral requirement should the PAR communicate to the patient?

Accepted Answer

A referral from the primary care physician is typically required to see a specialist

Answer

HMO plans generally require a referral from the patient's primary care physician before specialist visits are covered.

Question 3

Which document must a patient sign to acknowledge they understand their financial responsibility if Medicare is expected to deny a claim?

Accepted Answer

Advance Beneficiary Notice of Noncoverage (ABN)

Answer

The ABN notifies Medicare beneficiaries that a specific service may not be covered and that they will be responsible for payment.

Question 4

Which income-based program provides health coverage for low-income families, children, pregnant women, and certain adults?

Accepted Answer

Medicaid

Answer

Medicaid is a joint federal-state program that provides health coverage to eligible low-income individuals and families.

Question 5

A patient calls to ask about setting up a payment plan for a $1,200 balance. What information should the PAR collect first?

Accepted Answer

The patient's ability to pay, income information, and preferred payment schedule

Answer

Establishing a viable payment plan requires understanding the patient's financial situation and how much they can reasonably pay per period.

(PAR) Patient Access Representative Certification Practice Test