CRCR Financial Counseling and Patient Financial Services 1 — Questions and Answers
Question 1: What is the primary goal of financial counseling in the revenue cycle?
- To maximize hospital revenue at all costs
- To help patients understand and manage their financial obligations for healthcare services (Correct answer)
- To deny financial assistance to ineligible patients
- To replace the role of the billing department
Correct answer: To help patients understand and manage their financial obligations for healthcare services
Financial counseling focuses on educating patients about their financial responsibilities and available assistance options so they can make informed decisions.
Question 2: Which federal program provides health coverage to individuals with low incomes, including families, pregnant women, and people with disabilities?
- Medicare
- CHIP only
- Medicaid (Correct answer)
- TRICARE
Correct answer: Medicaid
Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families who meet eligibility requirements.
Question 3: A sliding fee scale in a financial assistance program bases a patient's discounted payment on which factor?
- The patient's credit score
- The patient's income relative to the Federal Poverty Level (FPL) (Correct answer)
- The type of diagnosis the patient has
- The physician's recommendation
Correct answer: The patient's income relative to the Federal Poverty Level (FPL)
Sliding fee scales use a patient's income as a percentage of the Federal Poverty Level to determine the appropriate discount tier for financial assistance.
Question 4: Under the Affordable Care Act (ACA), nonprofit hospitals that want to maintain tax-exempt status must have a written financial assistance policy (FAP). Which of the following is a required element of the FAP?
- A list of all insurance contracts the hospital has signed
- Eligibility criteria for financial assistance, including whether free or discounted care is available (Correct answer)
- The names of all employees authorized to grant assistance
- A record of all patients who previously received charity care
Correct answer: Eligibility criteria for financial assistance, including whether free or discounted care is available
The ACA requires nonprofit hospitals' FAPs to include eligibility criteria, the basis for calculating amounts charged, and how to apply for assistance.
Question 5: What does the term 'charity care' refer to in healthcare financial services?
- Discounts offered to insured patients only
- Care provided free of charge or at a reduced cost to patients who cannot afford to pay (Correct answer)
- Donations made by physicians to the hospital
- Government subsidies for hospital construction
Correct answer: Care provided free of charge or at a reduced cost to patients who cannot afford to pay
Charity care is the provision of free or discounted healthcare services to patients who are unable to pay, based on their demonstrated financial need.
Question 6: Which document is used by financial counselors to assess a patient's income, assets, and household size to determine eligibility for financial assistance programs?
- Advance Beneficiary Notice (ABN)
- Financial assistance application / charity care application (Correct answer)
- Assignment of Benefits form
- Medicare Secondary Payer (MSP) questionnaire
Correct answer: Financial assistance application / charity care application
A financial assistance or charity care application collects income, asset, and household information needed to evaluate a patient's eligibility for assistance programs.
Question 7: A financial counselor is helping an uninsured patient who is scheduled for a non-emergency procedure. What is the BEST first step the counselor should take?
- Require the patient to pay the full estimated cost upfront before any counseling
- Screen the patient for insurance coverage options and financial assistance eligibility (Correct answer)
- Refer the patient to a collection agency immediately
- Cancel the patient's appointment until payment arrangements are made
Correct answer: Screen the patient for insurance coverage options and financial assistance eligibility
Screening for coverage options and financial assistance eligibility is the appropriate first step to identify all potential resources available to the patient.
CRCR Financial Counseling and Patient Financial Services 1
What is the primary goal of financial counseling in the revenue cycle?