PAR Insurance Verification Processes 3

Question 1

Which government program provides health insurance specifically to individuals aged 65 and older, as well as certain younger individuals with disabilities?

Accepted Answer

Medicare

Answer

Medicare is the federal health insurance program primarily for people 65 and older, and also covers certain younger individuals with disabilities or end-stage renal disease.

Question 2

A patient has Medicare Part A and Part B. Which part covers physician office visits?

Accepted Answer

Part B

Answer

Medicare Part B covers outpatient services including physician office visits, while Part A covers inpatient hospital stays.

Question 3

When verifying a patient's TRICARE coverage, which unique piece of information is typically required that differs from commercial insurance verification?

Accepted Answer

The sponsor's military service branch and ID number

Answer

TRICARE coverage is based on the active duty or retired military sponsor's information, requiring the sponsor's branch of service and ID number for verification.

Question 4

A patient has a $2,000 deductible and has met $1,500 so far this year. The plan pays 80% after the deductible. A bill totals $1,000. How much does the patient owe?

Accepted Answer

$600

Answer

The patient applies the remaining $500 deductible first, then pays 20% coinsurance on the remaining $500 ($100), totaling $600.

Question 5

What does 'non-covered service' mean in the context of insurance verification?

Accepted Answer

A service excluded from coverage under the patient's plan benefits

Answer

Non-covered services are specifically excluded from the patient's benefit plan, meaning the insurer will not pay for them regardless of medical necessity.

(PAR) Patient Access Representative Certification Practice Test

(PAR) Patient Access Representative Certification Practice Test

PAR Insurance Verification Processes 3