CHAA Payer Types and Coordination of Benefits (COB) 2

Question 1

What is the primary difference between Medicare Part A and Medicare Part B coverage?

Accepted Answer

Part A covers inpatient hospital, skilled nursing, hospice, and home health; Part B covers outpatient services, physician visits, and preventive care

Answer

Part A covers drugs and Part B covers hospital stays

Answer

No difference between Part A and Part B

Answer

Part A is for over 65, Part B is for under 65

Question 2

A 67-year-old working patient has both Medicare and an employer group health plan. Which is primary?

Accepted Answer

The employer plan is primary if the employer has 20 or more employees

Answer

Medicare is always primary for patients over 65

Answer

The patient chooses

Answer

Both pay equally

Question 3

What is Medicaid, and how does it differ from Medicare?

Accepted Answer

Medicaid is a joint federal-state program for low-income individuals; Medicare is federal for those 65+ or with certain disabilities

Answer

They are the same program

Answer

Medicaid is only for children

Answer

Medicare is for low-income; Medicaid is for seniors

Question 4

For a dual-eligible patient (Medicare and Medicaid), what is the COB order?

Accepted Answer

Medicare is primary; Medicaid is secondary covering cost-sharing amounts

Answer

Medicaid is always primary

Answer

Patient chooses

Answer

Both pay simultaneously

Question 5

What is TRICARE, and which population does it serve?

Accepted Answer

The healthcare program for active duty military, veterans, retirees, and their families

Answer

A dental-only plan

Answer

A Medicaid managed care plan

Answer

Only covers emergencies

Question 6

What is subrogation in health insurance, and how does it affect patient access?

Accepted Answer

The insurer's right to recover costs from a third party responsible for the patient's injuries, requiring access staff to identify accident-related visits

Answer

Enrolling in a new plan

Answer

Only applies to auto insurance

Answer

The patient's right to choose any provider