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 eligible for both Medicaid and Medicare. In the revenue cycle, this patient is referred to as a:
Answer: Dual-eligible beneficiary
Patients covered by both Medicare and Medicaid are called dual-eligible beneficiaries; Medicare is billed first and Medicaid serves as the payer of last resort.
Which of the following BEST describes the purpose of a financial hardship application in the hospital revenue cycle?
Answer: To determine a patient's eligibility for reduced or waived charges based on income and assets
A financial hardship application assesses a patient's financial situation to determine eligibility for charity care or discounted care programs offered by the hospital.
A patient's insurance was terminated one month before a scheduled elective procedure, but the patient did not inform the hospital. The financial counselor discovers this at check-in. The BEST course of action is to:
Answer: Discuss self-pay options, payment plans, and potential assistance programs with the patient before proceeding
The financial counselor should present all available financial options to the patient so an informed decision can be made about proceeding with the elective service.
Under the Affordable Care Act (ACA), non-profit hospitals must meet which requirement related to financial assistance?
Answer: Establish and publicize a written Financial Assistance Policy (FAP)
Section 501(r) of the Internal Revenue Code, as part of the ACA, requires non-profit hospitals to have a written Financial Assistance Policy that is widely publicized to the community.
During financial counseling, a patient indicates they are a veteran. Which resource should the financial counselor consider exploring for coverage of the patient's healthcare costs?
Answer: Department of Veterans Affairs (VA) benefits
Veterans may be eligible for VA healthcare benefits that could cover or offset the cost of services received at civilian healthcare facilities.
A financial counselor notices that a patient with commercial insurance has a $500 copay due at time of service but is reluctant to pay. Routinely waiving copays for all patients would be considered:
Answer: A violation of the insurance contract and potentially fraudulent
Routinely waiving copays violates the provider's contract with the insurer and may constitute insurance fraud, as it misrepresents the patient's true financial liability.
When a patient's account is being considered for transfer to an external collection agency, which action must occur FIRST to comply with hospital financial assistance policy and regulatory requirements?
Answer: Verify that all internal financial assistance options have been exhausted and documented
Regulatory requirements and best practices mandate that all internal financial assistance options—including charity care screening—be fully exhausted and documented before transferring an account to collections.