CRCR CRCR - Certified Revenue Cycle Representative Program Patient Access and Registration 3

Question 1

A patient presents for an elective procedure without a referral from their PCP. The patient's insurance plan requires a referral for specialist visits. What should the patient access representative do?

Accepted Answer

Inform the patient that a referral is required and assist them in obtaining one before the procedure

Answer

Patient access staff must verify authorization and referral requirements before services are rendered to avoid claim denials.

Question 2

Which element is most critical to capture accurately during patient registration to ensure proper coordination of benefits (COB)?

Accepted Answer

Order of all insurance plans including primary and secondary payers

Answer

Accurate COB requires knowing which payer is primary and which is secondary so claims are submitted in the correct order.

Question 3

Under the Emergency Medical Treatment and Labor Act (EMTALA), what is a hospital's obligation when a patient arrives at the emergency department?

Accepted Answer

Screen and stabilize the patient regardless of ability to pay

Answer

EMTALA requires hospitals to provide a medical screening exam and stabilizing treatment to all patients regardless of insurance status or ability to pay.

Question 4

A patient disputes a financial counselor's estimate of their out-of-pocket costs. What is the best course of action?

Accepted Answer

Review the benefits verification details with the patient and document the interaction

Answer

Reviewing and explaining benefit details transparently builds patient trust and reduces billing disputes downstream.

Question 5

What is the purpose of a Hospital Issued Notice of Non-Coverage (HINN)?

Accepted Answer

To inform patients that their stay will not be covered by Medicare and explain their appeal rights

Answer

A HINN notifies Medicare beneficiaries when a hospital believes services are not covered, giving them the right to appeal.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR CRCR - Certified Revenue Cycle Representative Program Patient Access and Registration 3