The patient’s health plan is referred to as the 'payer of last resort.' The patient is covered by which plan?

Prepare for the NHA Certified Billing and Coding Specialist (CBCS) Exam with engaging quizzes. Study with multiple choice questions, each offering hints and explanations, to enhance your understanding and readiness for the exam!

Multiple Choice

The patient’s health plan is referred to as the 'payer of last resort.' The patient is covered by which plan?

Explanation:
Payer of last resort describes a plan that pays only after all other possible sources have been billed and exhausted. Medicaid is commonly described this way because it coordinates with other coverage (like private insurance or Medicare) and will pay any remaining eligible costs after those first payers have covered what they can. If a patient has private insurance, that plan typically pays first and Medicaid covers any remaining balance it is eligible to pay. If there is no other coverage, Medicaid acts as the primary payer. This role is why Medicaid is identified as the payer of last resort in this context.

Payer of last resort describes a plan that pays only after all other possible sources have been billed and exhausted. Medicaid is commonly described this way because it coordinates with other coverage (like private insurance or Medicare) and will pay any remaining eligible costs after those first payers have covered what they can. If a patient has private insurance, that plan typically pays first and Medicaid covers any remaining balance it is eligible to pay. If there is no other coverage, Medicaid acts as the primary payer. This role is why Medicaid is identified as the payer of last resort in this context.

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