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CHAM practice questions

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First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

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Question 1Patient Access Management

A patient arrives at the emergency department with chest pain and is registered before insurance verification is completed. Which registration process best describes this action?

  1. Scheduled admission
  2. Preregistration
  3. Emergency registration Correct answer.
  4. Precertification

Explanation

Emergency registration is used when a patient requires immediate treatment and full demographic and insurance data cannot be collected first. The registration is completed or updated after clinical stabilization. This protects access to care while still capturing a record.

Question 2Patient Access Management

A patient calls to book a follow-up visit and refuses to provide a Social Security number. What is the most appropriate patient access response?

  1. Enter a placeholder number such as 999-99-9999
  2. Ask the patient to mail the number before arrival
  3. Schedule the visit and document that the patient declined Correct answer.
  4. Refuse to schedule until the number is supplied

Explanation

Many organizations treat the Social Security number as optional for scheduling, so access staff should proceed and record the patient's refusal. Fabricating a placeholder number corrupts the record and can cause identity matching errors. Denying scheduling over a nonessential field obstructs access to care.

Question 3Patient Access Management

Which identifier should be used as the primary search key when matching a patient to an existing medical record?

  1. Preferred pharmacy name
  2. Insurance member ID
  3. Full legal name and date of birth Correct answer.
  4. Home address

Explanation

Patient matching relies on core demographic data such as legal name, date of birth, and often sex or address. These fields are stable and present in nearly every record. Insurance and pharmacy details change and are unsuitable as primary matching keys.

Question 4Patient Access Management

A patient presents an insurance card showing coverage that terminated two months ago. What should the registrar do first?

  1. Copy the card and process the visit without comment
  2. Cancel the appointment until coverage is proven
  3. Verify current eligibility and ask whether other coverage exists Correct answer.
  4. Bill the patient as self-pay for the entire balance

Explanation

The registrar should confirm current eligibility through the payer and screen for other active coverage. Terminated coverage does not automatically mean the patient is uninsured. Denying care or assuming self-pay before verification is premature.

Question 5Patient Access Management

Which document typically authorizes a facility to bill a patient's health plan for covered services?

  1. Notice of privacy practices
  2. Consent for treatment
  3. Assignment of benefits Correct answer.
  4. Advance beneficiary notice

Explanation

Assignment of benefits directs the payer to reimburse the provider for covered services. It is commonly obtained at registration along with the financial responsibility signature. Consent for treatment and privacy notices serve different legal purposes.

Question 6Patient Access Management

A patient with no insurance needs a non-urgent outpatient procedure. Which patient access action best supports both the patient and the organization?

  1. Refer the patient to another facility
  2. Schedule the procedure and defer all financial discussion
  3. Provide a good-faith estimate and screen for financial assistance Correct answer.
  4. Require full payment before the procedure is scheduled

Explanation

Uninsured patients should receive a good-faith estimate of expected charges and be screened for financial assistance or payment plans. This supports informed financial consent and reduces bad debt. Deferring all discussion or demanding full prepayment creates avoidable barriers.

Question 7Patient Access Management

What is the primary purpose of scheduling templates in patient access?

  1. To store patient insurance card images
  2. To standardize appointment slot availability by provider and visit type Correct answer.
  3. To record clinical progress notes
  4. To calculate the facility's charity care budget

Explanation

Scheduling templates define which appointment slots are open for each provider, resource, and visit type. They maximize utilization and prevent inappropriate bookings. Insurance storage, budgeting, and clinical documentation belong to other systems.

Question 8Patient Access Management

A patient requests an interpreter for a registration interview. What is the most appropriate action?

  1. Proceed in English and have the patient sign later
  2. Ask the patient to bring a family member next time
  3. Use a qualified medical interpreter through the approved service Correct answer.
  4. Ask a bilingual housekeeping staff member to interpret

Explanation

Patients with limited English proficiency are entitled to qualified interpretation, typically through an approved in-person or video/telephonic service. Untrained staff and family members risk miscommunication on consent and financial matters. Delaying the interview undermines informed registration.

Question 9Patient Access Management

A registration clerk notices two records with the same name and date of birth but different medical record numbers. What is this situation called?

  1. Identity theft
  2. Duplicate medical record Correct answer.
  3. Record overlay
  4. Merge rejection

Explanation

A duplicate medical record occurs when the same patient is registered more than once under separate record numbers. Duplicates fragment the clinical history and increase safety risk. Overlays and merges are the corrective processes, not the condition itself.

Question 10Patient Access Management

A patient is scheduled for an elective inpatient surgery next week. When should precertification ideally be obtained?

  1. Only if the payer denies the claim later
  2. After the patient is discharged
  3. Before the scheduled service date Correct answer.
  4. On the day of surgery at check-in

Explanation

Precertification must be secured from the payer before the elective service is rendered. Obtaining it in advance confirms medical necessity and payment terms. Waiting until discharge or after a denial forfeits the payer's authorization window.

Question 11Patient Access Management

A self-pay patient asks how much a scheduled CT scan will cost. Which practice best meets transparency expectations?

  1. Provide a good-faith estimate of expected out-of-pocket cost Correct answer.
  2. Decline to discuss cost until after the service
  3. Quote the hospital's full charge master price only
  4. Refer the patient to the insurer's website only

Explanation

Price transparency guidance expects providers to give uninsured and self-pay patients a good-faith estimate of expected charges. The estimate should reflect likely patient responsibility rather than the undiscounted charge master rate alone. Refusing to discuss cost undermines informed financial consent.

Question 12Patient Access Management

During registration, a patient states she has coverage through her employer and also through her spouse's plan. What should the registrar do?

  1. Determine coordination of benefits order with both payers Correct answer.
  2. Ask the patient to drop one plan before service
  3. Record only the employer plan and ignore the other
  4. Bill only the plan the patient names first

Explanation

When a patient has dual coverage, the payers determine which plan is primary through coordination of benefits rules. The registrar should capture both plans and follow the determined order. Ignoring a plan or asking the patient to drop coverage can cause denials and inaccurate liability.

Question 13Patient Access Management

A patient arrives for an appointment and reports a new address and phone number. What is the correct registration action?

  1. Note the change in a free-text comment only
  2. Update the demographics and confirm identity before saving Correct answer.
  3. Create a new medical record with the new address
  4. Leave the old data to avoid altering the record

Explanation

Demographic changes should be captured in the designated fields after confirming the patient's identity. Structured updates keep the record accurate for billing and clinical communication. Creating a new record or using free-text notes fragments the chart.

Question 14Patient Access Management

Which element is essential on a signed consent for treatment at registration?

  1. The registrar's home department code
  2. A description of the procedure's clinical risks
  3. The patient's employer name
  4. The patient or legally authorized representative's signature and date Correct answer.

Explanation

A valid consent for treatment requires the signature of the patient or a legally authorized representative and the date. This documents voluntary agreement to care. Employer data and internal codes are unrelated, and detailed risk disclosure belongs to informed consent for specific procedures.

Question 15Patient Access Management

A patient misses a scheduled appointment without calling. Which action best supports access management and continuity?

  1. Charge a penalty without notifying the patient
  2. Close the patient's record permanently
  3. Cancel all future appointments for the patient
  4. Document the no-show and follow the organization's rebooking outreach policy Correct answer.

Explanation

No-shows should be documented and addressed through the organization's outreach and rebooking policy. This preserves access for other patients while keeping the patient engaged in care. Punitive or permanent actions without policy basis raise access and compliance concerns.

Question 16Patient Access Management

A patient's employer plan requires a referral from a primary care provider before a specialist visit. What should the registrar confirm before the visit?

  1. That the specialist is board certified
  2. That the referral is on file and valid for the visit date Correct answer.
  3. That the patient has completed a satisfaction survey
  4. That the patient has paid the specialist copay

Explanation

When a plan requires referrals, the registrar must confirm a valid referral is on file and covers the scheduled date and specialist. Missing or expired referrals commonly cause claim denials. Copays, credentials, and surveys do not substitute for referral verification.

Question 17Patient Access Management

Which metric best measures how completely patient access staff collect required registration data before service?

  1. Average call handle time
  2. Registration data completeness rate Correct answer.
  3. Bed turnover ratio
  4. Claim appeal overturn rate

Explanation

A registration data completeness rate measures the percentage of accounts with all required fields captured before service. This directly reflects access data quality and predicts downstream denials. Call time, bed turnover, and appeal outcomes measure other processes.

Question 18Patient Access Management

A patient without identification arrives for a scheduled outpatient visit. What is the most appropriate first step?

  1. Use approved alternate identity verification and document the method Correct answer.
  2. Ask another patient to confirm the patient's identity
  3. Register the patient under a generic name
  4. Turn the patient away until ID is presented

Explanation

Organizations should have an alternate identity verification process for patients lacking standard ID, such as verifying via prior records or approved secondary questions. The method used must be documented to preserve record integrity. Denying care or using generic names creates safety and billing risks.

Question 19Patient Access Management

A patient's insurance requires prior authorization for an MRI, but the order arrives the same day. What is the best access workflow response?

  1. Contact the payer for urgent authorization and reschedule if required Correct answer.
  2. Cancel the order entirely
  3. Bill the patient as self-pay without notice
  4. Perform the MRI and pursue authorization afterward

Explanation

Same-day orders requiring authorization should trigger an urgent payer request, with rescheduling if approval cannot be obtained in time. This protects the patient from unexpected liability and the organization from denials. Performing first or billing self-pay without notice shifts risk unfairly.

Question 20Patient Access Management

A registrar notices that a patient's stated date of birth differs by one digit from the record found in the MPI. What is the safest action?

  1. Register a new patient record with the corrected date
  2. Investigate with additional identifiers before making any change Correct answer.
  3. Overwrite the record's date of birth immediately
  4. Ignore the discrepancy since one digit is minor

Explanation

A discrepancy in a key identifier requires investigation using additional data such as address, prior visits, or photo ID before any change. Premature edits can corrupt an existing patient's record. Creating a new record or ignoring the discrepancy risks duplicates or overlays.

Question 21Patient Access Management

A patient signs a financial responsibility form but later claims she was never told she might owe a balance. Which practice most reduces this risk?

  1. Documenting a verbal explanation of estimated responsibility at registration Correct answer.
  2. Having the patient initial only the last page
  3. Relying solely on the signature on the form
  4. Mailing the form after the visit

Explanation

Best practice combines the signed form with documentation that the patient received a verbal explanation of potential financial responsibility. This supports informed consent and defensible billing. Signature alone, delayed forms, or partial initials do not demonstrate understanding.

Question 22Patient Access Management

An access manager finds that 30 percent of denied claims stem from incorrect insurance plan selection at registration. Which intervention addresses the root cause?

  1. Shorten appointment slot lengths
  2. Increase the charity care budget
  3. Hire more appeals specialists
  4. Implement payer-specific plan selection prompts and staff training Correct answer.

Explanation

The root cause is plan selection error, so the fix is to make plan choice more reliable through payer-specific prompts and targeted training. Appeals staff treat symptoms after denial. Charity budgets and slot lengths do not affect plan selection accuracy.

Question 23Patient Access Management

A patient with limited English proficiency needs to sign a financial responsibility form. Which approach best meets both access and compliance needs?

  1. Postpone all financial discussion indefinitely
  2. Provide interpretation of the form's content and document the language used Correct answer.
  3. Have the patient sign the English form without explanation
  4. Ask the patient's child to explain the form

Explanation

Financial consent is meaningful only if the patient understands it, so the form's content should be interpreted and the language of service documented. This aligns language access requirements with informed financial consent. Using a child or skipping explanation undermines validity.

Question 24Patient Access Management

Two patients with identical names are both scheduled in the same clinic on the same day. Which safeguard most directly prevents a wrong-patient registration?

  1. Relying on the appointment time as the identifier
  2. Verifying at least two identifiers and checking the MPI for both patients Correct answer.
  3. Asking the patients to sort out the confusion
  4. Scheduling them at the same time to save slots

Explanation

Verifying at least two patient identifiers and searching the MPI prevents selecting the wrong same-name record. This is a core patient safety practice in access. Time-based or patient-driven identification is unreliable and unsafe.

Question 25Patient Access Management

A patient's coverage requires notification within 24 hours of an emergency admission. Registration learns of the admission at hour 20. What is the priority action?

  1. Wait for the next business day to notify the payer
  2. Ask the patient to notify the payer after discharge
  3. Notify the payer immediately and document the notification Correct answer.
  4. Assume the payer will discover the admission automatically

Explanation

When a payer requires timely admission notification, access staff must notify within the window and document the contact. Acting at hour 20 preserves the benefit and avoids denial. Waiting, assuming automatic notice, or delegating to the patient risks missing the deadline.

Question 26Patient Access Management

Which patient access activity is performed first when a patient arrives for a scheduled outpatient visit?

  1. Scheduling the patient's next follow-up appointment
  2. Verifying the patient's identity and updating demographic information Correct answer.
  3. Confirming the patient's preferred pharmacy for prescriptions
  4. Collecting the patient's copayment for the visit

Explanation

Patient access begins with accurate identification and demographic verification to ensure the correct record is used and to support safe care. Financial and scheduling tasks follow after identity is confirmed.

Question 27Patient Access Management

A patient provides an insurance card that shows a PPO plan, but the patient says the plan changed last month. What should the registrar do first?

  1. Ask the patient for the most current card or confirmation of the active plan Correct answer.
  2. Schedule the patient with a financial counselor instead of registering
  3. Collect the full self-pay amount because coverage is uncertain
  4. Enter the plan from the card and note the discrepancy in the account

Explanation

The registrar should obtain the most current coverage information before entering data, because using outdated plan details can cause claim denials. Verification against the payer or a current card is the appropriate first step.

Question 28Patient Access Management

Which data element is most important to capture during registration to support both patient safety and accurate billing?

  1. The patient's legal name and date of birth Correct answer.
  2. The patient's employer address
  3. The patient's preferred language for written materials
  4. The patient's emergency contact phone number

Explanation

Legal name and date of birth are core identifiers used to match the patient to the correct medical record and to verify eligibility with payers. These identifiers directly support safe care and accurate claim submission.

Question 29Patient Access Management

A patient calls to cancel a scheduled MRI because of transportation problems. What is the most appropriate access response?

  1. Transfer the patient to the billing office to discuss the cost of the MRI
  2. Cancel the appointment and tell the patient to call back when transportation is available
  3. Offer to reschedule and ask whether transportation assistance or a telehealth alternative is needed Correct answer.
  4. Mark the appointment as a no-show and document the reason

Explanation

Access management aims to preserve continuity of care, so staff should offer rescheduling and explore barriers such as transportation. Documenting the reason and connecting the patient to resources supports both access and scheduling efficiency.

Question 30Patient Access Management

Which action best protects patient privacy at a registration desk located in a busy lobby?

  1. Asking patients to write their information on a clipboard and return it later
  2. Announcing the patient's full name and appointment type when calling them forward
  3. Lowering the voice and using a privacy screen or private area for sensitive discussions Correct answer.
  4. Discussing insurance details only after the patient's name is called loudly

Explanation

Privacy at registration requires minimizing the chance that others overhear protected health information. Speaking quietly and using a privacy screen or private space are standard safeguards.

Question 31Patient Access Management

What is the purpose of collecting a patient's signature on the Conditions of Admission form during registration?

  1. To transfer the patient's care to a specialist without further consent
  2. To document the patient's consent to treatment and acknowledgment of financial responsibility Correct answer.
  3. To authorize the hospital to release information to the patient's employer
  4. To confirm the patient has read the hospital's marketing materials

Explanation

The Conditions of Admission form typically records consent to treatment and the patient's agreement to pay for services. It is a core registration document that supports both clinical authorization and financial accountability.

Question 32Patient Access Management

Which metric best indicates the timeliness of the patient access process for scheduled outpatient visits?

  1. The average time from patient arrival to completion of registration Correct answer.
  2. The percentage of patients who arrive more than 15 minutes early
  3. The number of registration staff scheduled per shift
  4. The total number of appointments scheduled each day

Explanation

Registration cycle time measures how quickly patients move through the access process after arrival. This metric directly reflects timeliness and operational efficiency.

Question 33Patient Access Management

A patient asks whether a specific procedure is covered by her plan. What is the most appropriate response from patient access staff?

  1. Quote the hospital's standard self-pay price as the final patient responsibility
  2. Guarantee that the procedure is covered because the order was written by a network physician
  3. Tell the patient to call the payer herself because access staff cannot discuss benefits
  4. Explain that coverage depends on the payer's medical policy and offer to verify benefits Correct answer.

Explanation

Coverage determinations depend on the payer's medical policy and the patient's specific benefits. Access staff should verify benefits and avoid guaranteeing coverage, while helping the patient understand the process.

Question 34Patient Access Management

During registration, a patient says she has Medicare and a supplemental plan. Which sequence best supports accurate coordination of benefits?

  1. Enter the supplemental plan as primary because it pays faster
  2. Enter only Medicare because supplemental plans do not require registration data
  3. Enter Medicare as primary and the supplemental plan as secondary, then verify both Correct answer.
  4. Ask the patient to choose which plan should be billed first

Explanation

Medicare is generally primary and the supplemental plan secondary when both are active. Entering both plans in the correct order supports proper coordination of benefits and reduces denials.

Question 35Patient Access Management

A patient's insurance requires preauthorization for an outpatient procedure, but the authorization has not been obtained. What should patient access do before the service?

  1. Proceed with scheduling and notify the patient that authorization is her responsibility
  2. Cancel the procedure and tell the patient to reschedule after the new year
  3. Register the patient as self-pay and collect the full estimated charge
  4. Contact the payer or ordering provider to obtain authorization and document the status Correct answer.

Explanation

When authorization is required, access staff should initiate or confirm the authorization before the service to prevent denial. Documenting the status keeps the care team informed and supports follow-up.

Question 36Patient Access Management

A patient with limited English proficiency arrives for registration without an interpreter. What is the best action?

  1. Ask the patient to return with an English-speaking friend
  2. Use a bilingual family member to interpret the registration interview
  3. Arrange qualified interpreter services before completing the registration Correct answer.
  4. Proceed with registration using gestures and written numbers

Explanation

Qualified interpreter services support accurate communication and informed consent, and are required for meaningful access. Relying on family members or gestures risks miscommunication and privacy concerns.

Question 37Patient Access Management

A patient is being registered for an elective procedure and states that she has a signed advance directive. What should the registrar do?

  1. Discard the directive because it is not needed for an elective procedure
  2. Ask the patient whether she wants the directive scanned into the record and notify clinical staff Correct answer.
  3. Tell the patient that advance directives are not part of registration
  4. Place the directive in the financial file and continue registration

Explanation

Advance directives are part of the patient's medical record and should be documented and communicated to clinical staff. The registrar should respect the patient's wishes and ensure the document is available to caregivers.

Question 38Patient Access Management

Which action best supports a patient's right to choose a representative to receive protected health information?

  1. Requiring the patient to submit a court order for every request
  2. Releasing information only to the patient's employer
  3. Allowing any family member who calls to receive information without documentation
  4. Obtaining a signed authorization or representative designation before releasing information Correct answer.

Explanation

Patients may designate a personal representative, but access staff must document the designation or obtain a valid authorization before releasing protected health information. This balances patient rights with privacy requirements.

Question 39Patient Access Management

A patient is scheduled for a high-cost imaging study and asks for an estimate of out-of-pocket cost. What should patient access do?

  1. Refer the patient to a public website that lists average national prices
  2. Provide a good-faith estimate based on verified benefits and document that it was given Correct answer.
  3. Quote the hospital's full charge without considering insurance benefits
  4. Tell the patient that estimates are not available until after the claim processes

Explanation

Price transparency expectations call for a good-faith estimate of patient responsibility based on verified benefits. Documenting the estimate supports communication and compliance.

Question 40Patient Access Management

A patient reports that she has no primary care provider but her insurance requires one for specialist visits. What is the best access action?

  1. Register the patient as self-pay for the specialist visit
  2. Help the patient identify an in-network PCP and obtain a referral before scheduling the specialist Correct answer.
  3. Cancel all future appointments until the patient provides a PCP name
  4. Schedule the specialist visit and tell the patient to find a PCP later

Explanation

When a plan requires a PCP referral, access staff should help the patient meet that requirement to avoid denial and support continuity. Identifying an in-network PCP and obtaining the referral are appropriate steps.

Question 41Patient Access Management

A patient's registration form lists a different last name than the insurance card. What should the registrar do?

  1. Ignore the discrepancy because it does not affect care
  2. Use the name on the insurance card for all records
  3. Change the insurance card information to match the registration form
  4. Ask the patient to clarify the discrepancy and update the record with documented legal name Correct answer.

Explanation

Name discrepancies can cause eligibility and claim errors, so the registrar should clarify with the patient and document the legal name. Using verified information supports accurate record matching and billing.

Question 42Patient Access Management

Which practice best supports collecting patient financial responsibility at the time of service?

  1. Asking patients to pay whatever amount they choose
  2. Waiting until after the claim is processed to discuss any balance
  3. Estimating patient responsibility during pre-registration and offering payment options Correct answer.
  4. Requiring full payment before insurance is billed

Explanation

Point-of-service collection is improved when staff estimate patient responsibility in advance and discuss payment options. This approach supports transparency and reduces later collection issues.

Question 43Patient Access Management

A patient is being registered for a same-day add-on procedure. What is the most important access step to complete before the procedure?

  1. Confirm the order, verify insurance eligibility, and check whether authorization is required Correct answer.
  2. Schedule the patient's next routine visit
  3. Collect the patient's home address for marketing purposes
  4. Ask the patient to complete a satisfaction survey

Explanation

Same-day add-on procedures still require a valid order, eligibility verification, and authorization review to prevent denials and support safe care. These steps should be completed before the service when possible.

Question 44Patient Access Management

A patient's employer changes insurance carriers effective the first of the month. The patient is scheduled for surgery on the fifth. What should access staff do?

  1. Verify the new coverage and update the account before the surgery date Correct answer.
  2. Ask the patient to reschedule until the old plan is active again
  3. Bill the old carrier because the surgery was scheduled earlier
  4. Register the patient as self-pay until the new card arrives

Explanation

Coverage effective dates determine which payer is responsible, so the account must be updated with the new plan before the service. Verifying the new coverage prevents billing the wrong carrier.

Question 45Patient Access Management

A patient is registering for an inpatient stay and is unable to provide a next of kin. What is the best action?

  1. Ask the patient if there is someone who can be contacted and document the response Correct answer.
  2. Refuse to complete registration until a contact is provided
  3. Leave the field blank and proceed with registration
  4. List the patient's employer as the emergency contact

Explanation

Emergency contact information supports care coordination, but the patient has the right to decline. The registrar should ask, document the response, and proceed without delaying care.

Question 46Patient Access Management

Which approach best supports accurate patient identification when a patient cannot provide a photo ID?

  1. Use the patient's insurance card number as the only identifier
  2. Use two other identifiers, such as full name and date of birth, and follow organizational policy Correct answer.
  3. Deny service until a photo ID is presented
  4. Ask another patient to confirm the patient's identity

Explanation

When photo ID is unavailable, policy-based use of two identifiers helps maintain accurate identification without denying care. This approach balances safety and access.

Question 47Patient Access Management

An access manager wants to reduce registration errors that lead to claim denials. Which action is most directly effective?

  1. Ask patients to review their own claims after discharge
  2. Implement real-time eligibility verification and targeted staff education on common denial causes Correct answer.
  3. Reduce the data collected at registration to speed up the process
  4. Increase the number of registration staff without changing training

Explanation

Real-time eligibility verification catches coverage issues before service, and targeted education addresses root causes of errors. Together these actions directly reduce registration-related denials.

Question 48Patient Access Management

A patient is scheduled for a procedure that requires a signed informed consent. The patient arrives without a signed form. What should access staff do?

  1. Have the patient sign the consent at registration after confirming the procedure and provider Correct answer.
  2. Ask the patient's family member to sign without the patient's involvement
  3. Cancel the procedure permanently
  4. Proceed with the procedure and obtain consent afterward

Explanation

Informed consent must be obtained before the procedure, and registration staff often facilitate the signature after confirming the procedure and provider. The clinical team remains responsible for ensuring the consent is informed.

Question 49Patient Access Management

A patient with a high-deductible plan is scheduled for an elective procedure. How can access staff best support the patient financially?

  1. Provide an estimate of the deductible amount owed and offer a payment plan before the service Correct answer.
  2. Wait until the claim is denied to discuss payment
  3. Tell the patient the deductible does not apply to elective procedures
  4. Collect the entire hospital charge regardless of insurance

Explanation

For high-deductible plans, estimating the patient's out-of-pocket responsibility and offering payment options supports transparency and collection. This proactive approach reduces financial surprises.

Question 50Patient Access Management

A patient is being registered for a clinical trial. What access consideration is most important?

  1. Registering the patient as self-pay to avoid insurance complications
  2. Scheduling the patient without checking authorization because trials are exempt
  3. Confirming that the trial sponsor, not the patient's insurance, always pays all costs
  4. Verifying the patient's insurance benefits and documenting the trial's billing arrangement Correct answer.

Explanation

Clinical trial billing can be complex, and access staff should verify benefits and document how routine versus research costs will be billed. Assuming the sponsor pays everything or that authorization is unnecessary can lead to errors.