CRCR Patient Access and Front-End Processes 2

Question 1

What is the purpose of pre-registration in the patient access workflow?

Accepted Answer

To gather and verify patient demographic and insurance information before the date of service to streamline check-in and identify issues early

Answer

To collect copayments before the patient arrives

Answer

To conduct a preliminary medical screening

Answer

To schedule the patient's follow-up appointment

Question 2

Which of the following best describes a referral authorization in managed care?

Accepted Answer

Approval from the primary care physician or insurer that allows a patient to see a specialist while keeping the service covered under the plan's benefit structure

Answer

A physician's permission for a patient to be discharged

Answer

A request for medical records from a prior provider

Answer

An employer's approval for an employee to use sick leave for a medical appointment

Question 3

What is the function of the admission type code on a UB-04 claim?

Accepted Answer

It indicates whether the admission was emergency, urgent, elective, or newborn affecting claim processing and payment

Answer

It identifies the patient's primary diagnosis

Answer

It records the patient's admitting physician's NPI

Answer

It indicates whether the patient has Medicare or commercial insurance

Question 4

What is admission status classification and why does it matter for billing?

Accepted Answer

Whether the patient is classified as an inpatient or observation outpatient which significantly affects billing and patient cost-sharing

Answer

Whether the patient has a private or shared room

Answer

The floor or unit where the patient is admitted

Answer

Whether the patient has been pre-registered for admission

Question 5

Why is it important to collect the patient's guarantor information at registration?

Accepted Answer

To identify the financially responsible party for the account when the patient is a minor or incapacitated

Answer

To provide the patient's credit score to the billing department

Answer

To determine the patient's insurance deductible

Answer

To verify the patient's employment history

Question 6

What is the Minimum Data Set requirement for skilled nursing facility admissions?

Accepted Answer

A federally required comprehensive assessment tool that determines care needs and drives Medicare payment for SNF residents

Answer

The minimum insurance information required to bill Medicare

Answer

A list of minimum documentation required before discharge

Answer

The minimum staffing ratios required for a Medicare-certified SNF