Chapter 32 — Exercises

How to use these. Section H is the chapter. Writing the patient explanation is the one skill here that no software will ever do for you, and the exercises ask you to write it out in full — not bullet points, the actual words. Read your drafts aloud; a sentence you would not say to a frightened person across a counter is a sentence to cut.

Section B's arithmetic must foot. Every figure you need is frozen in Chapters 2, 23, 24, and 26. If your numbers do not reconcile to the anchor accounts, the error is yours, and finding it is the exercise.

And Section I should be attempted before reading §32.11. Everything you need is in Chapters 2, 24, and 28.

Section A — The patient as payer (items 1–8)

A.1 The chapter maps each insurer-side tool to a missing patient-side equivalent. Complete the table: eligibility verification → ? · remittance advice → ? · the payer contract → ? · the coverage policy → ?

A.2 State the combined patient responsibility on the ED anchor (Accounts 22-7788 and 10-7789), and show the three components that build it.

A.3 "Nonpayment is the patient's CARC, and it always reads 'information insufficient.'" Name five distinct root causes that produce the identical symptom of a patient not paying.

A.4 Who holds most medical debt in the United States — the insured or the uninsured? Name three mechanisms from this book that produce medical debt in insured people.

A.5 Why does a patient balance depreciate faster than a payer balance of the same age? Give both the structural reason and the behavioral one.

A.6 Name the five case studies in this book in which a patient did everything right and was harmed, and state the one-sentence thread they share.

A.7 This chapter claims the patient-respecting design and the revenue-maximizing design are the same design. State the argument in two sentences.

A.8 A practice manager says, "Patients who don't pay are choosing not to." Using §32.1, write the three-sentence correction.

Section B — Estimates (items 9–18)

B.9 Name the four inputs to a patient estimate (Chapter 24 §24.9), and mark the one the practice cannot see.

B.10 An estimate is built from which number — the charge or the allowed amount? Why is the other one useless for this purpose?

B.11 For the scheduled knee injection (20610 allowed \$78.60, J1030 allowed \$6.28, 20% coinsurance, deductible met): compute the estimate. Now compute it with the deductible not met. Show both checks.

B.12 List five elements a good estimate document contains beyond the number itself.

B.13 Why must an estimate state where the service will occur? Quote the two frozen patient-share figures for Account 10-4471's encounter in the two settings, and compute the difference.

B.14 A patient is referred to "the orthopedic clinic on the hospital's second floor." What question should the referring practice's staff be able to answer, and what two consequences follow if the answer is "it is provider-based"?

B.15 Write the one sentence an estimate for a screening colonoscopy must contain, and explain which anchor account exists because it was missing.

B.16 An estimate tool is discovered to be loading last year's fee schedule. Name the update cycles that govern the codes an estimate is keyed to, and state what a stale-rate estimate does to patient trust that a stale-rate claim does not.

B.17 Chapter 24 says "the sentence matters more than the number." Write the sentence, in your own words, for the \$16.98 injection estimate.

B.18 Why does the estimate in §32.2's figure translate the contractual adjustment for the patient ("the difference is written off — you never owe it")? What phone call does that line prevent?

Section C — The No Surprises Act (items 19–30)

C.19 Define balance billing, and distinguish it from cost sharing in one sentence each. Which lives inside the allowed amount?

C.20 Where was balance billing always prohibited, and by what mechanism in each case? (Three answers: in network, Medicare, Medicaid.)

C.21 Who is entitled to a good faith estimate under current rules? What insured-patient equivalent does the statute contemplate, and what is its status?

C.22 Name five required contents of a GFE.

C.23 What is the patient-provider dispute resolution process, who can invoke it, and what triggers eligibility?

C.24 List the categories of service protected from balance billing by the No Surprises Act, and the one prominent ambulance category federal law does not yet reach.

C.25 What is the qualified payment amount, and what is it used for from the patient's chair?

C.26 The notice-and-consent exception: what is it for, and name three circumstances in which it can never be used.

C.27 Why can an out-of-network anesthesiologist at an in-network hospital never balance bill, even with a signed patient consent?

C.28 The IDR process: who are the parties, what style of arbitration is it, and why does the patient never appear in it?

C.29 A protected patient's statement shows coinsurance computed on the provider's full charge. Name everything wrong, and state what the cost sharing should have been computed from.

C.30 A billing system cannot tell protected claims from ordinary out-of-network claims. Describe the "scrubber-grade edit on the statement side" §32.3 says almost nobody has built.

Section D — Price transparency (items 31–37)

D.31 Name the two publications the Hospital Price Transparency rule requires, and the five kinds of standard charge in the first.

D.32 What is a shoppable service, and what may a hospital offer in place of the consumer-friendly display?

D.33 Describe the enforcement arc since 2021 — what early compliance looked like, and what CMS's response became.

D.34 What does the Transparency in Coverage rule add, and what number is now public "from both directions"?

D.35 Name the three things §32.5 says a revenue cycle professional should do with transparency files, and connect the second to Chapter 26 §26.5.

D.36 A patient calls quoting your hospital's machine-readable file at you. Per Chapter 23 §23.8 and this chapter: what has this caller done, and what is the wrong way to receive them?

D.37 How do transparency files change the underpayment method of Chapter 28 §28.8 and the contract negotiation of Chapter 23 §23.6?

Section E — The statement (items 38–47)

E.38 List the seven questions every statement must answer. Which one do American statements most systematically omit, and what does its absence do?

E.39 Reconstruct Account 10-4471's statement #1 from memory: responsibility, credit, balance due, and the issue date. Show the arithmetic check.

E.40 What is "the sentence that stops the phone call," and why does it work? Connect it to its payer-side twin on the CMS-1500.

E.41 Why did statement #1 wait until day 70? What would have been wrong with issuing it on day 20, and what would the payer's second remittance have done to a day-20 statement?

E.42 State the two timing rules for statements, and the failure each prevents.

E.43 Why must a statement name the services in words rather than codes alone?

E.44 The ED anchor generates two statements from two organizations. What must each statement say to keep the patient from reading the second as a duplicate or an error?

E.45 A statement's largest number is the charge. Using Chapter 28 §28.2's EOB discussion, explain what the patient will conclude and why.

E.46 Design task. Draft a one-page statement template for your practice that answers all seven questions, shows credits, and carries the assistance line. Annotate each element with the section of this chapter that requires it.

E.47 Account 10-4471's patient paid thirty days after one statement, with no call. List every design and process decision from this chapter that contributed to that outcome.

Section F — Plans and assistance (items 48–58)

F.48 Name the four disciplines of an in-house payment plan.

F.49 Compute a twelve-month plan for the \$439.28 facility balance. Show that it foots.

F.50 Why does a payment plan need a minimum installment at all — and what is wrong with setting the floor above what the patient can pay?

F.51 Third-party patient financing: state the two questions that decide whether an offering is honest, and explain the deferred-interest trap in terms a patient would understand.

F.52 What must happen to the collection machinery while a plan is current, and why?

F.53 What does §501(r) require of a nonprofit hospital's financial assistance policy? Four elements.

F.54 What does the "amounts generally billed" limitation protect against, and which Chapter 23 figure is the bill it displaces?

F.55 Define extraordinary collection action and give four examples. What must precede any of them?

F.56 Define presumptive eligibility and name four data signals it can run on. Why does the application-based path systematically fail the people the policy is for?

F.57 Why is routinely waiving cost sharing a compliance problem rather than a kindness? Name the statutes implicated and the compliant alternative.

F.58 State the operational rule "screen before you chase," and trace what it changes at three points in the account lifecycle.

Section G — Collections (items 59–66)

G.59 Whom does the FDCPA govern, and whom does it generally not? What fills the gap, and what posture does §32.9 recommend regardless?

G.60 Summarize the recent transformation in medical-debt credit reporting, and state what it does to a collections strategy that assumed the credit report was leverage.

G.61 "Placement is delegation, not disposal." List five oversight disciplines for a collection agency relationship.

G.62 Name four categories of balance that must never be placed.

G.63 Define propensity to pay, and describe the two directions the same score can be used. Which direction does §32.8 require checking first, and why does the same low score point both ways?

G.64 Run the reputational math on a small-balance placement: what does the agency's remittance show, and what costs never appear on it?

G.65 Why does §32.9 say the goal is "not to do collections well so much as to need it rarely"? Connect the sentence to Chapter 29's identical argument about denials.

G.66 Case Study 2's aggressive program "survived exactly as long as nobody outside the organization could see it." Name the earlier chapter whose case study had the same detectable-from-outside structure.

Section H — Explaining the bill (items 67–73)

H.67 List the seven steps of the conversation in §32.10, in order.

H.68 Why is "start from their document, not your screen" the first rule? What goes wrong when the explainer starts from the account view?

H.69 Write the patient explanation. A caller holds the ED facility statement: charge \$3,842.00, their share \$439.28, and this morning a second bill for \$63.72 arrived. Write your half of the conversation in full — the actual words, not an outline. It must: defuse the fear first, explain the charge-versus-share distinction, explain the second bill, give the combined total and say it is final, and offer both a plan and the assistance policy without being asked.

H.70 Write the patient explanation. The colonoscopy caller: "I was promised a free screening. Somebody coded this wrong." Write your response in full. It must confirm what the caller got right, explain screening-became-diagnostic without jargon, state the phase-down honestly with the verify-current caveat, and never blame the caller, the coder, or the payer.

H.71 Write the patient explanation. Account 10-4471's patient calls on day 18 holding an EOB that shows a denied line: "My insurance denied my visit. Do I owe the whole \$185.00?" Using Chapter 28 §28.3 (CO means the patient may not be billed) and §32.6's timing rule, write the response. It must answer the actual fear (no, you do not owe it), explain why no statement is coming yet, and say what will happen next.

H.72 Name the three "never" rules in step 6, and for each, write the sentence a well-meaning staffer says that violates it.

H.73 "I can't pay this" — what is it, if it is almost never a refusal? What does the person who understands that do next?

Section I — The Encounter (items 74–79)

I.74 From the frozen calendar: when did statement #1 go out, what three numbers did it carry, and when was it paid?

I.75 Reconstruct the two-stage estimate: what could have been quoted at scheduling, and what could have been added in the room before consent? Show that the stages sum to the frozen \$47.58.

I.76 Why could no scheduling-time estimate have included the injection? Which chapter established that, and which document records the in-room decision?

I.77 Was a statutory good faith estimate owed to this patient? Why or why not — and why does §32.11 argue the answer does not matter to the practice's obligation?

I.78 Between day 0 and day 70, what financial information did the patient actually receive, and from whom? What confusion did the sequence invite, and which section of Chapter 28 staged the resulting phone call?

I.79 The file closes at \$0.00 on day 100. State the five figures of the final position (charges, allowed, plan, patient, adjustment) and the one question about this account that remains open — and name the only chapter allowed to answer it.