CRCR - Certified Revenue Cycle Representative Program Patient Access and Registration Flashcards

What is the primary goal of pre-registration in the revenue cycle?

Answer: To gather and verify patient demographic and insurance information before the date of service

Pre-registration allows staff to collect and verify key information in advance, reducing day-of delays, errors, and insurance denials.

A patient's secondary insurance plan is Medicaid. In what order should claims generally be submitted?

Answer: Primary insurance first, then Medicaid as secondary

Medicaid is always the payer of last resort; the primary insurance must be billed first, and Medicaid covers only eligible remaining balances.

Which of the following is NOT typically collected during the patient registration process?

Answer: Patient's clinical diagnosis from previous encounters

Clinical diagnoses are determined by clinicians and documented in the medical record, not collected by registration staff during the administrative intake process.

A guarantor on a patient account is best described as:

Answer: The individual financially responsible for the account

The guarantor is the person legally responsible for paying the patient's account, which may be the patient themselves or a parent/guardian.

What action should a patient access representative take when they identify a duplicate medical record number for the same patient?

Answer: Notify the HIM (Health Information Management) department to perform a record merge or overlay review

Duplicate medical record numbers must be reported to HIM for proper resolution to protect patient safety and data integrity.

Under HIPAA's Minimum Necessary Standard, what does patient access staff need to keep in mind when sharing patient information?

Answer: Only the minimum amount of protected health information needed for the purpose should be disclosed

The Minimum Necessary Standard requires covered entities to limit PHI access and disclosure to only what is required to accomplish the intended purpose.

A patient expresses concern about a bill received for a service they believed was covered by their insurance. What is the most appropriate first step for the patient access or billing representative?

Answer: Review the Explanation of Benefits (EOB) with the patient to understand how the claim was processed

Reviewing the EOB helps identify whether the claim was processed correctly and whether an appeal, correction, or further education is needed.