Chapter 32 — Quiz
26 questions. Answers and explanations are in the instructor guide.
1. Most medical debt in the United States is held by people who were:
- A. Uninsured when the care was delivered
- B. Insured when the care was delivered
- C. Enrolled in Medicaid
- D. Out of network by choice
2. A patient estimate is computed from:
- A. The charge and the chargemaster
- B. The allowed amount and the benefit design
- C. The gross collection rate
- D. Last year's statements
3. For Account 10-4471's encounter, the frozen patient shares are \$47.58 at the independent office and, in the provider-based counterfactual:
- A. \$47.58 — the setting does not change cost sharing
- B. \$63.72
- C. \$84.52
- D. \$153.00
4. An estimate for a screening colonoscopy must say that:
- A. The procedure is always free
- B. A polyp found and removed converts the procedure to diagnostic, and cost sharing may apply
- C. The patient should decline polyp removal to preserve the screening benefit
- D. Pathology is never billed separately
5. Under current rules, a good faith estimate is required for:
- A. All patients
- B. Medicare beneficiaries only
- C. Uninsured and self-pay patients
- D. Patients who request an appeal
6. The patient-provider dispute resolution process is triggered when:
- A. Any claim is denied
- B. An uninsured or self-pay patient is billed substantially more than the good faith estimate
- C. A plan and a provider disagree about an out-of-network payment
- D. A statement is issued before the remittance posts
7. Balance billing is:
- A. Any amount the patient owes
- B. Billing the patient for cost sharing within the allowed amount
- C. Billing the patient for the difference between the charge and the allowed amount
- D. A synonym for coinsurance
8. Under the No Surprises Act, which provider can NEVER balance bill via notice and consent?
- A. An out-of-network orthopedic surgeon the patient chose for a scheduled procedure
- B. An out-of-network anesthesiologist at an in-network facility
- C. An in-network hospitalist
- D. A participating provider under Medicare
9. For a protected out-of-network claim, the patient's cost sharing is generally based on:
- A. The provider's full charge
- B. The chargemaster
- C. A qualified payment amount or applicable state law
- D. Whatever the provider and plan later negotiate
10. The federal IDR process under the No Surprises Act is between:
- A. The patient and the provider
- B. The patient and the plan
- C. The plan and the provider
- D. CMS and the state
11. Ground ambulance balance billing is:
- A. Prohibited by the No Surprises Act
- B. Not yet reached by the federal act; state law governs
- C. Prohibited only for Medicare
- D. Impossible because ambulances are always in network
12. The hospital machine-readable file must include all of the following EXCEPT:
- A. Payer-specific negotiated rates
- B. The discounted cash price
- C. De-identified minimum and maximum negotiated rates
- D. Each patient's individual out-of-pocket history
13. A hospital may satisfy the shoppable-services display requirement with:
- A. A posted chargemaster
- B. A compliant online price-estimator tool
- C. A statement mailed on request
- D. Nothing; there is no alternative
14. Statement #1 for Account 10-4471 shows:
- A. \$47.58 due
- B. \$47.58 responsibility, a \$30.00 credit, and \$17.58 due
- C. \$17.58 responsibility with no credit shown
- D. \$367.00 due pending insurance
15. "The sentence that stops the phone call" is:
- A. The legal disclaimer
- B. The visible credit line acknowledging the payment already made
- C. "This is not a bill"
- D. The CARC and RARC printed in full
16. Statement #1 waited until day 70 because:
- A. The mailroom was behind
- B. Statements are always sent quarterly
- C. The balance was not final until the second remittance posted on day 66
- D. The patient requested a delay
17. The question American statements most systematically fail to answer is:
- A. Who is billing me?
- B. What do I owe now?
- C. What if I can't pay this?
- D. What was it for?
18. An account on a current payment plan:
- A. Continues to age toward placement
- B. Must not be placed, reported, or escalated
- C. Accrues interest by default
- D. Is written off as bad debt
19. The two questions that decide whether third-party patient financing is honest are:
- A. Recourse, and what the patient signs
- B. Volume, and the discount rate
- C. Brand, and the application time
- D. Interest, and the practice's margin
20. §501(r) requires a nonprofit hospital to do all of the following EXCEPT:
- A. Maintain and widely publicize a written financial assistance policy
- B. Limit charges to FAP-eligible patients to amounts generally billed
- C. Make reasonable efforts to determine FAP eligibility before extraordinary collection actions
- D. Forgive all patient balances regardless of income
21. Presumptive eligibility exists because:
- A. Applications are legally prohibited
- B. The population most likely to qualify is the population least likely to complete an application
- C. It is cheaper to deny assistance
- D. The IRS requires zero documentation
22. Routinely waiving copays and deductibles for federal program beneficiaries is:
- A. Required by the No Surprises Act
- B. Always permissible as charity
- C. A potential Anti-Kickback Statute and beneficiary-inducement problem
- D. A billing error with no consequences
23. The FDCPA directly governs:
- A. Third-party debt collectors
- B. Every practice collecting its own accounts in its own name
- C. Payers
- D. Credit bureaus only
24. A low propensity-to-pay score, used honestly, should first trigger:
- A. Immediate placement
- B. A lawsuit
- C. Financial assistance and presumptive-eligibility screening
- D. A larger minimum payment
25. In §32.10's conversation, "I can't pay this" is best understood as:
- A. A refusal to pay
- B. The opening of a negotiation the caller does not know they are allowed to have
- C. A dispute of the coding
- D. A request for a collection agency
26. The two-stage estimate in §32.11 shows that Account 10-4471's patient could have known the full \$47.58:
- A. Only after the appeal was decided
- B. Only on day 70
- C. Before the injection was performed, from information already in the system
- D. Never — the denial made it unknowable