PAR Insurance Verification Processes 2

Question 1

A patient presents with two insurance plans. Which coordination of benefits rule determines which plan pays first?

Accepted Answer

The birthday rule applies when a patient is covered under both parents' plans

Answer

The birthday rule states that the parent whose birthday falls earliest in the calendar year has the primary insurance plan for dependent children.

Question 2

When verifying insurance for an outpatient surgical procedure, which information is MOST critical to confirm beyond basic eligibility?

Accepted Answer

Whether prior authorization is required for the specific procedure code

Answer

Prior authorization requirements for surgical procedures must be confirmed before the procedure to avoid claim denial.

Question 3

A patient's insurance card shows 'OON' benefits. What does this indicate?

Accepted Answer

The plan offers out-of-network benefits with different cost-sharing

Answer

OON stands for out-of-network, indicating the plan provides some coverage when using providers outside the preferred network, typically at higher cost-sharing.

Question 4

During verification, you discover a patient's Medicaid coverage was terminated last month. What is the FIRST action to take?

Accepted Answer

Inform the patient of the lapse and explore coverage options before services are rendered

Answer

The patient must be informed of the coverage lapse so they can make informed decisions about proceeding with care and payment options.

Question 5

Which term describes the fixed dollar amount a patient pays for a covered service, regardless of the total charge?

Accepted Answer

Copayment

Answer

A copayment (copay) is a predetermined fixed fee the patient pays at the time of service, separate from deductibles and coinsurance.

(PAR) Patient Access Representative Certification Practice Test

(PAR) Patient Access Representative Certification Practice Test

PAR Insurance Verification Processes 2