CRCR CRCR - Certified Revenue Cycle Representative Program Point-of-Service Collections 4 — Questions and Answers
Question 1: Under the No Surprises Act, which type of estimate must providers give self-pay patients before scheduled services?
- Good Faith Estimate (GFE) (Correct answer)
- Advance Beneficiary Notice (ABN)
- Explanation of Benefits (EOB)
- Prior Authorization Summary
Correct answer: Good Faith Estimate (GFE)
The No Surprises Act requires providers to issue a Good Faith Estimate to uninsured or self-pay patients before scheduled services.
Question 2: When collecting a copay, a registration specialist notices the patient's insurance plan has a 'copay waiver' notation for preventive visits. What should the specialist do?
- Waive the copay per the plan's benefit design for preventive services (Correct answer)
- Collect the copay and let the patient request a refund later
- Collect the copay as standard policy
- Defer to the physician to decide
Correct answer: Waive the copay per the plan's benefit design for preventive services
Many insurance plans waive copays for preventive visits per ACA requirements, and collecting one would result in a refund and patient dissatisfaction.
Question 3: Which of the following is a key reason POS collections reduce accounts receivable (AR) days?
- Collecting at time of service eliminates the need to bill and follow up for patient balances after the visit (Correct answer)
- POS collections replace insurance billing entirely
- Patients pay faster when billed by mail
- Insurance companies process claims faster when POS collections occur
Correct answer: Collecting at time of service eliminates the need to bill and follow up for patient balances after the visit
Collecting patient responsibility upfront prevents those balances from entering the AR cycle, reducing overall AR days outstanding.
Question 4: A patient's insurance requires a $30 specialist copay, but the patient is seeing an out-of-network provider. What is the CORRECT POS action?
- Collect the out-of-network cost-sharing amount, which may be higher, and inform the patient of potential balance billing (Correct answer)
- Collect the standard $30 copay as listed
- Collect nothing since the provider is out-of-network
- Require the patient to obtain a referral before any collection
Correct answer: Collect the out-of-network cost-sharing amount, which may be higher, and inform the patient of potential balance billing
Out-of-network services typically carry higher patient cost-sharing, and patients should be clearly informed of their financial responsibility upfront.
Question 5: What is the primary purpose of a financial counselor in the POS collections workflow?
- To assess patient financial need, explain liability estimates, and connect patients with payment options or assistance programs (Correct answer)
- To submit claims to insurance companies on behalf of patients
- To authorize procedures with payers
- To audit billing codes before claims are sent
Correct answer: To assess patient financial need, explain liability estimates, and connect patients with payment options or assistance programs
Financial counselors help patients understand their financial obligations and navigate payment plans, charity care, or government assistance programs before or after service.
Question 6: Which scenario represents 'presumptive charity care' in a POS collections context?
- Automatically qualifying a patient for financial assistance based on demographic data and public records without requiring an application (Correct answer)
- Presuming the patient can pay based on their insurance coverage
- Waiving a copay for a longtime patient as a courtesy
- Presuming a claim will be denied and not billing the insurer
Correct answer: Automatically qualifying a patient for financial assistance based on demographic data and public records without requiring an application
Presumptive charity care uses data such as income indicators and public records to proactively qualify patients for assistance, reducing bad debt.
Question 7: A patient disputes the estimated out-of-pocket amount at check-in, claiming their insurer said they owed nothing. What is the BEST immediate action?
- Verify coverage in real time with the payer and document the result before proceeding (Correct answer)
- Accept the patient's claim and waive the collection
- Refuse service until the patient contacts their insurer
- Collect the estimate and advise the patient to dispute with their insurer afterward
Correct answer: Verify coverage in real time with the payer and document the result before proceeding
Real-time eligibility verification resolves discrepancies at the point of service by obtaining authoritative benefit information directly from the payer.
CRCR CRCR - Certified Revenue Cycle Representative Program Point-of-Service Collections 4
Under the No Surprises Act, which type of estimate must providers give self-pay patients before scheduled services?