Certified Revenue Cycle Representative (CRCR) Practice Exam

What are out-of-pocket payments?

1. Payments made by insurers for covered services

2. Cash payments made by the insured for services not covered by the plan

3. Automatic deductions from salaries for healthcare

4. Reimbursements from insurance companies

The correct answer is: Cash payments made by the insured for services not covered by the plan

Out-of-pocket payments refer specifically to the expenses that individuals incur for healthcare services that are not reimbursed by their insurance. This includes cash payments for services or procedures that may not be covered by an individual's health insurance plan, such as certain elective services, deductibles, copayments, and other costs that the insured must pay from their own finances. Understanding out-of-pocket payments is crucial in the revenue cycle because they directly impact the financial responsibilities of patients and affect billing processes. These payments can also influence patient care decisions, as individuals may be deterred from seeking necessary care due to the financial burden associated with out-of-pocket costs. Other options, like payments made by insurers or reimbursements, involve transactions between payers and providers rather than direct payments made by the insured.