CRCR Financial Counseling and Patient Financial Services 3

Question 1

A patient who qualifies for Medicaid but has not yet been enrolled comes to a hospital for emergency services. What must the hospital do under EMTALA?

Accepted Answer

Provide a medical screening exam and necessary stabilizing treatment regardless of the patient's ability to pay

Answer

Refuse services until Medicaid enrollment is confirmed

Answer

Bill only the patient's primary care provider

Answer

Require a cash deposit before rendering any care

Question 2

What is the '240% rule' associated with nonprofit hospital financial assistance policies under the ACA?

Accepted Answer

Hospitals cannot charge uninsured qualifying patients more than 240% of what Medicare would pay for the same services

Answer

Hospitals must charge no more than 240% of Medicare rates

Answer

Patients earning 240% of the FPL automatically qualify for full charity care

Answer

Hospitals must respond to financial assistance applications within 240 hours

Question 3

When a financial counselor identifies that a patient has both Medicare and Medicaid coverage, the patient is called a 'dual eligible.' Which payer is billed FIRST?

Accepted Answer

Medicare, as the primary payer, with Medicaid as the payer of last resort

Answer

Medicaid, because it is the federal program

Answer

Either payer, depending on the provider's preference

Answer

The patient is billed directly for all services

Question 4

Which federal law prohibits hospitals from billing patients for surprise medical bills from out-of-network providers in emergency situations (effective January 2022)?

Accepted Answer

The No Surprises Act

Answer

HIPAA

Answer

The Balanced Budget Act

Answer

COBRA

Question 5

A patient states they cannot pay their $5,000 balance and refuses a payment plan. What is the appropriate next step for the financial counselor BEFORE sending the account to collections?

Accepted Answer

Screen the patient again for financial assistance eligibility and document all counseling efforts

Answer

Immediately transfer the account to a third-party collection agency

Answer

Write off the balance without any further follow-up

Answer

Add a lien to the patient's property

Question 6

Which of the following best describes 'bad debt' in a hospital's financial context?

Accepted Answer

Balances owed by patients who are expected to pay but have not, after all collection efforts are exhausted

Answer

Care provided to patients who qualify for charity care

Answer

Accounts of patients who were determined eligible for Medicaid

Answer

Contractual adjustments written off per payer contracts

Question 7

What is the key distinction between a 'financial clearance' process and standard financial counseling?

Accepted Answer

Financial clearance verifies insurance, estimates patient liability, and collects payment or sets up a plan BEFORE the service is rendered

Answer

Financial clearance only applies to emergency patients

Answer

Financial counseling occurs only after discharge, while clearance occurs during the visit

Answer

There is no meaningful distinction between the two processes