Financial Counseling and Patient Financial Services Flashcards
7 cards from real CRCR practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Financial Counseling and Patient Financial Services flashcards as text
A patient who qualifies for Medicaid but has not yet been enrolled comes to a hospital for emergency services. What must the hospital do under EMTALA?
Answer: Provide a medical screening exam and necessary stabilizing treatment regardless of the patient's ability to pay
EMTALA requires hospitals with emergency departments to provide a medical screening exam and stabilizing treatment to any individual regardless of insurance status or ability to pay.
What is the '240% rule' associated with nonprofit hospital financial assistance policies under the ACA?
Answer: Hospitals cannot charge uninsured qualifying patients more than 240% of what Medicare would pay for the same services
The ACA limits what nonprofit hospitals can charge uninsured patients who qualify for financial assistance to the amounts generally billed to insured patients, often referenced against Medicare-based benchmarks.
When a financial counselor identifies that a patient has both Medicare and Medicaid coverage, the patient is called a 'dual eligible.' Which payer is billed FIRST?
Answer: Medicare, as the primary payer, with Medicaid as the payer of last resort
For dual eligible patients, Medicare is always billed first as the primary payer, and Medicaid covers remaining cost-sharing as the payer of last resort.
Which federal law prohibits hospitals from billing patients for surprise medical bills from out-of-network providers in emergency situations (effective January 2022)?
Answer: The No Surprises Act
The No Surprises Act, effective January 1, 2022, protects patients from unexpected out-of-network bills for emergency care and certain non-emergency situations at in-network facilities.
A patient states they cannot pay their $5,000 balance and refuses a payment plan. What is the appropriate next step for the financial counselor BEFORE sending the account to collections?
Answer: Screen the patient again for financial assistance eligibility and document all counseling efforts
Before collections, financial counselors should ensure patients are fully screened for assistance programs and that all counseling attempts are thoroughly documented.
Which of the following best describes 'bad debt' in a hospital's financial context?
Answer: Balances owed by patients who are expected to pay but have not, after all collection efforts are exhausted
Bad debt refers to amounts owed by patients who have the financial ability to pay but have not paid despite collection efforts, distinct from charity care provided to those who cannot pay.
What is the key distinction between a 'financial clearance' process and standard financial counseling?
Answer: Financial clearance verifies insurance, estimates patient liability, and collects payment or sets up a plan BEFORE the service is rendered
Financial clearance is a proactive pre-service process that confirms insurance benefits, calculates estimated patient responsibility, and secures payment commitments before care is provided.