CRCR CRCR - Certified Revenue Cycle Representative Program Patient Access and Registration 2 — Questions and Answers
Question 1: What is the purpose of collecting an Advance Beneficiary Notice from Medicare patients?
- To obtain authorization for Medicare billing
- To notify the patient that Medicare may not cover a service and give them the option to decide whether to receive it and accept financial responsibility (Correct answer)
- To verify the patient's Medicare eligibility
- To comply with HIPAA privacy requirements
Correct answer: To notify the patient that Medicare may not cover a service and give them the option to decide whether to receive it and accept financial responsibility
The ABN informs patients of potential non-coverage by Medicare so they can make informed decisions about receiving the service.
An Advance Beneficiary Notice is a written notice that providers must give to Medicare patients before providing a service that Medicare may not cover. The ABN informs the patient that Medicare might deny the claim and asks the patient to decide whether to receive the service and accept financial responsibility if Medicare does not pay. Without a valid ABN the provider generally cannot bill the patient for services Medicare denies as not medically necessary.
Question 2: During patient registration a staff member notices the patient's insurance information has changed from the previous visit. What is the most appropriate action?
- Use the old insurance information to avoid delaying the patient
- Update the demographic and insurance records immediately and re-verify eligibility with the new payer (Correct answer)
- Ask the patient to call their insurance company directly
- Leave the update for the billing department to handle after the visit
Correct answer: Update the demographic and insurance records immediately and re-verify eligibility with the new payer
Insurance information should be updated in the system and re-verified at the time of registration to prevent billing delays and denials.
When a patient reports a change in insurance the registrar should immediately update the record and verify eligibility with the new payer before the service is rendered. Using outdated insurance information leads to claim rejections, delayed payment, and additional rework. Patient access is the first and most critical point in the revenue cycle for ensuring accurate information.
Question 3: Which federal law requires hospitals to provide emergency medical screening and stabilization regardless of a patient's ability to pay?
- HIPAA
- EMTALA the Emergency Medical Treatment and Labor Act (Correct answer)
- The Affordable Care Act
- The No Surprises Act
Correct answer: EMTALA the Emergency Medical Treatment and Labor Act
EMTALA prohibits hospitals from refusing emergency care or transferring unstable patients based on their financial status.
EMTALA requires Medicare-participating hospitals with emergency departments to provide a medical screening examination to any patient who presents with an emergency medical condition and to stabilize the patient or provide an appropriate transfer regardless of the patient's ability to pay. Violations can result in significant civil monetary penalties and exclusion from Medicare participation.
Question 4: What is a point-of-service collection at patient registration and why is it important?
- Collecting copayments, deductibles, or deposits from the patient at the time of service (Correct answer)
- Confirming the patient's location for billing purposes
- Verifying insurance eligibility at the registration desk
- Issuing the patient a receipt for cash payments only
Correct answer: Collecting copayments, deductibles, or deposits from the patient at the time of service
Collecting patient-owed amounts at the time of service significantly improves collection rates compared to post-service billing.
Point-of-service collection is the practice of collecting copayments, deductibles, coinsurance, or deposits at the time the patient registers or receives care rather than sending a bill afterward. Research consistently shows that collections are significantly higher when patient financial responsibility is addressed before or during the visit.
Question 5: What information must be included in the HIPAA Notice of Privacy Practices?
- The patient's insurance deductible
- How the covered entity uses and discloses PHI, patient rights regarding their health information, and how to file a complaint (Correct answer)
- The provider's billing rates and fee schedules
- The patient's diagnosis and treatment plan
Correct answer: How the covered entity uses and discloses PHI, patient rights regarding their health information, and how to file a complaint
The NPP informs patients of their rights under HIPAA and how their protected health information may be used.
The HIPAA Notice of Privacy Practices must explain how the covered entity uses and discloses protected health information, the patient's rights including the right to access their records and file a complaint, the organization's duties to protect PHI, and how patients can file a complaint with HHS if they believe their privacy rights have been violated.
Question 6: What is the purpose of the Medicare Secondary Payer questionnaire in patient registration?
- To determine if the patient qualifies for Medicare Part D drug coverage
- To identify whether Medicare should be primary or secondary payer based on the patient's other insurance coverage (Correct answer)
- To verify the patient's Medicare enrollment date
- To calculate the patient's Medicare deductible for the current year
Correct answer: To identify whether Medicare should be primary or secondary payer based on the patient's other insurance coverage
The MSP questionnaire determines the correct payer order when Medicare patients have other insurance coverage.
The Medicare Secondary Payer questionnaire is required at registration for Medicare patients to determine whether Medicare should pay primary or secondary. Medicare is secondary when the patient has active employer-sponsored group health insurance for large employers, workers' compensation, or automobile insurance for the specific condition. Failing to identify an MSP situation creates a Medicare overpayment that must be refunded.
CRCR CRCR - Certified Revenue Cycle Representative Program Patient Access and Registration 2
What is the purpose of collecting an Advance Beneficiary Notice from Medicare patients?