Patient Access and Registration Flashcards

A patient scheduled for a same-day surgery is found to lack the required pre-authorization. The registrar should:

Answer: Notify the surgeon and authorization team immediately so authorization can be obtained or the case rescheduled

Timely notification allows the clinical and authorization teams to obtain approval or make an informed decision about rescheduling, protecting the patient and the facility's reimbursement.

Which of the following BEST describes 'insurance portability' as it relates to HIPAA?

Answer: Employees can maintain continuous health coverage when changing jobs without being denied due to pre-existing conditions

The portability provisions of HIPAA protect workers from losing health coverage due to pre-existing conditions when transitioning between employer-sponsored health plans.

A patient's insurance requires a $50 copay at time of service. The patient says they will pay on the way out. Best practice dictates the registrar should:

Answer: Collect the copay before or at the time of the encounter per facility policy

Point-of-service copay collection is standard best practice and reduces the cost of downstream billing and collections; consistent collection also satisfies payer contract requirements.

When verifying a Medicaid patient's eligibility, the registrar learns coverage ended the previous month. The appropriate next step is to:

Answer: Inform the patient of the lapse and screen for Medicaid reinstatement or other financial assistance

A coverage lapse requires immediate patient notification and financial counseling to explore reinstatement, other coverage, or charity care options before or after service.

Which of the following is considered a 'front-end' revenue cycle function directly performed by the patient access team?

Answer: Verifying insurance eligibility prior to the patient visit

Eligibility verification is a pre-service, front-end function; payment posting and denial appeals are mid- and back-end revenue cycle activities.

A guarantor is BEST defined as:

Answer: The individual financially responsible for the patient's account

The guarantor is the person legally responsible for paying the account, which may be the patient, a parent, a spouse, or another designated individual.

During a scheduled pre-registration call, the patient reports a change in their employer and insurance plan. The registrar must:

Answer: Update the account immediately and re-verify eligibility and benefits under the new plan

Timely account updates and re-verification prevent claim denials caused by billing an outdated or inactive plan and ensure authorization requirements for the new plan are met.