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

EMTALA requires hospitals with emergency departments to provide a medical screening exam and stabilizing treatment to any individual regardless of insurance status or ability to pay.

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

The ACA limits what nonprofit hospitals can charge uninsured patients who qualify for financial assistance to the amounts generally billed to insured patients, often referenced against Medicare-based benchmarks.

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

For dual eligible patients, Medicare is always billed first as the primary payer, and Medicaid covers remaining cost-sharing as the payer of last resort.

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

The No Surprises Act, effective January 1, 2022, protects patients from unexpected out-of-network bills for emergency care and certain non-emergency situations at in-network facilities.

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

Before collections, financial counselors should ensure patients are fully screened for assistance programs and that all counseling attempts are thoroughly documented.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR Financial Counseling and Patient Financial Services 3