CRCR CRCR - Certified Revenue Cycle Representative Program Patient Access and Registration 4 — Questions and Answers
Question 1: A patient who speaks limited English arrives for registration. What is the most appropriate action under Title VI of the Civil Rights Act?
- Ask a bilingual family member to interpret all medical and financial information
- Provide a qualified medical interpreter at no cost to the patient (Correct answer)
- Hand the patient written materials in English and proceed
- Decline to register the patient until they can return with a translator
Correct answer: Provide a qualified medical interpreter at no cost to the patient
Title VI requires healthcare facilities receiving federal funding to provide meaningful access to services for patients with limited English proficiency, including qualified interpreter services.
Question 2: When verifying insurance eligibility electronically, which response status indicates that the patient's coverage is active?
- 271 transaction with active coverage segment (Correct answer)
- 270 transaction with subscriber ID
- 835 remittance advice
- 837 claim submission acknowledgment
Correct answer: 271 transaction with active coverage segment
The HIPAA 271 transaction (Eligibility/Benefit Response) is returned by payers to confirm a patient's active coverage status.
Question 3: A self-pay patient presents for a non-emergent service. What is the most appropriate financial counseling approach?
- Require full payment before the appointment
- Discuss charity care, payment plans, and any available financial assistance programs (Correct answer)
- Refer the patient to a collection agency immediately
- Proceed without financial discussion to avoid patient discomfort
Correct answer: Discuss charity care, payment plans, and any available financial assistance programs
Financial counselors should proactively discuss all available options including charity care and payment plans to help self-pay patients access needed care.
Question 4: Which federal program provides health coverage for individuals aged 65 and older, as well as certain younger individuals with disabilities?
- Medicaid
- CHIP
- Medicare (Correct answer)
- TRICARE
Correct answer: Medicare
Medicare is the federal health insurance program primarily for people aged 65 or older and certain people with disabilities under 65.
Question 5: What does the term 'clean claim' mean in revenue cycle management?
- A claim that has been paid in full by the payer
- A claim submitted with all required data elements that can be processed without additional information (Correct answer)
- A claim that has been through utilization review
- A claim with no patient balance remaining
Correct answer: A claim submitted with all required data elements that can be processed without additional information
A clean claim contains all necessary information for the payer to process it without requesting additional data, reducing delays in reimbursement.
Question 6: A Medicare patient is admitted as inpatient. The physician later changes the status to observation. What notice must the hospital provide?
- Advance Beneficiary Notice (ABN)
- Important Message from Medicare (IMM)
- Important Message About Your Care in a Hospital (MOON) (Correct answer)
- Notice of Privacy Practices
Correct answer: Important Message About Your Care in a Hospital (MOON)
The Medicare Outpatient Observation Notice (MOON) must be provided to Medicare patients receiving observation services for more than 24 hours.
Question 7: Which of the following is an example of a hard coding practice in patient access?
- Manually entering a diagnosis code based on clinical documentation
- Assigning a standard procedure code to all patients visiting a specific department regardless of service rendered (Correct answer)
- Verifying insurance eligibility in real time
- Obtaining a signed consent form
Correct answer: Assigning a standard procedure code to all patients visiting a specific department regardless of service rendered
Hard coding assigns the same charge code to all patients in a department automatically, which can cause billing errors if the code doesn't match the actual service.
CRCR CRCR - Certified Revenue Cycle Representative Program Patient Access and Registration 4
A patient who speaks limited English arrives for registration.
What is the most appropriate action under Title VI of the Civil Rights Act?