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 is uninsured and requires emergency surgery costing $45,000. Which financial assistance program should the financial counselor explore FIRST?
Answer: Screen the patient for Medicaid eligibility retroactive to the date of service
Retroactive Medicaid eligibility screening is the first step for uninsured patients facing emergency services, as it may cover the entire bill.
Under EMTALA, a hospital's financial counseling obligations regarding patients seeking emergency care include:
Answer: Discussing payment options only after the patient is stabilized
EMTALA prohibits delaying the medical screening exam for financial reasons; financial counseling occurs after the patient is medically stabilized.
A financial counselor is calculating a patient's estimated out-of-pocket cost. The patient has met $1,200 of a $3,000 annual deductible and has a 20% coinsurance with a $6,000 out-of-pocket maximum. The planned procedure costs $8,000. What is the patient's estimated liability?
Answer: $2,960
Remaining deductible is $1,800; after deductible, 20% coinsurance on $6,200 = $1,240; but the OOP cap is $6,000, so total patient liability from the OOP perspective is $1,800 + $1,160 = $2,960.
Which federal law requires hospitals to provide patients with a 'Good Faith Estimate' of expected charges before a scheduled service?
Answer: The No Surprises Act
The No Surprises Act, effective January 2022, requires providers to give uninsured and self-pay patients a Good Faith Estimate at least three business days before a scheduled service.
A patient declines a payment plan and states they cannot afford any portion of their $2,500 balance. The most appropriate next action for the financial counselor is to:
Answer: Screen the patient for charity care or financial assistance eligibility
Financial counselors must offer charity care screening before escalating to collections, as many patients who decline payment plans may qualify for assistance.
When a patient has both Medicare Part A and a Medigap (supplemental) policy, the financial counselor should understand that Medigap typically covers:
Answer: Medicare Part A deductibles and coinsurance
Medigap policies are designed to fill gaps in Original Medicare, including Part A deductibles and coinsurance amounts not covered by Medicare.
A financial counselor is assisting a patient who received an Explanation of Benefits (EOB) showing a claim was denied as 'not medically necessary.' The best immediate action is to:
Answer: Coordinate with the clinical team to gather supporting documentation for an appeal
Medical necessity denials are commonly overturned on appeal when clinical documentation supporting the need for the service is submitted to the payer.