CRCR Financial Counseling and Patient Financial Services 2 — Questions and Answers
Question 1: Which term describes the out-of-pocket amount a patient must pay each year before their insurance plan begins paying benefits?
- Copayment
- Coinsurance
- Deductible (Correct answer)
- Premium
Correct answer: Deductible
A deductible is the annual amount a patient must pay out-of-pocket before their health insurance plan starts covering most services.
Question 2: What is 'presumptive eligibility' in the context of Medicaid and financial counseling?
- A process where Medicaid automatically enrolls all uninsured patients
- A temporary determination that a patient is likely eligible for Medicaid based on preliminary information, allowing coverage to begin immediately (Correct answer)
- A denial of Medicaid based on assumed income
- A process requiring full documentation before any care is provided
Correct answer: A temporary determination that a patient is likely eligible for Medicaid based on preliminary information, allowing coverage to begin immediately
Presumptive eligibility allows qualified entities to make a temporary Medicaid eligibility determination so patients can receive covered services while their full application is processed.
Question 3: A financial counselor uses a 'propensity to pay' score for a patient. What does this score measure?
- The likelihood that a patient will refer other patients to the hospital
- The probability that a patient will pay their bill based on financial and behavioral data (Correct answer)
- The patient's credit score from a major bureau
- The amount of charity care the patient has historically received
Correct answer: The probability that a patient will pay their bill based on financial and behavioral data
A propensity to pay score uses financial and demographic data to predict how likely a patient is to pay their bill, helping staff prioritize financial counseling efforts.
Question 4: Which type of payment plan allows a patient to pay their balance in fixed monthly installments over a set period without interest?
- Revolving credit line
- Interest-free installment agreement (Correct answer)
- Medical credit card with deferred interest
- A recourse loan
Correct answer: Interest-free installment agreement
An interest-free installment agreement allows patients to spread their balance across monthly payments without incurring additional interest charges.
Question 5: Under HIPAA, when can a financial counselor share a patient's account balance information with a patient's family member who is present during counseling?
- Never — HIPAA prohibits any disclosure to family members
- Only with the patient's written authorization on file
- When the patient is present and does not object, or when the patient has given prior permission (Correct answer)
- Only when the family member is listed as an insurance subscriber
Correct answer: When the patient is present and does not object, or when the patient has given prior permission
HIPAA allows disclosure of relevant information to family members or friends involved in a patient's care when the patient is present and does not object or has previously given permission.
Question 6: What is the primary purpose of the Medical Debt Relief Act provisions that some states have enacted?
- To allow hospitals to charge higher rates to uninsured patients
- To limit aggressive collection practices and remove certain medical debt from credit reports (Correct answer)
- To require patients to pay all bills before receiving future care
- To mandate that hospitals sue patients who do not pay within 30 days
Correct answer: To limit aggressive collection practices and remove certain medical debt from credit reports
Medical debt relief legislation in various states aims to protect patients from aggressive collection practices and reduce the negative impact of medical debt on credit scores.
Question 7: Which of the following is an example of a 'soft credit check' that financial counselors may use?
- Pulling a full credit report that is visible to all lenders
- Reviewing a patient's financial profile to assess payment capacity without impacting their credit score (Correct answer)
- Sending a patient's account to a collection agency
- Reporting a patient's balance to the IRS
Correct answer: Reviewing a patient's financial profile to assess payment capacity without impacting their credit score
A soft credit check reviews financial data to assess a patient's ability to pay without appearing on their credit report or affecting their credit score.
CRCR Financial Counseling and Patient Financial Services 2
Which term describes the out-of-pocket amount a patient must pay each year before their insurance plan begins paying benefits?