CRCR Financial Counseling and Patient Financial Services 4 — Questions and Answers
Question 1: A patient is uninsured and requires emergency surgery costing $45,000. Which financial assistance program should the financial counselor explore FIRST?
- Apply for a medical credit card on the patient's behalf
- Screen the patient for Medicaid eligibility retroactive to the date of service (Correct answer)
- Require a deposit before proceeding with the procedure
- Refer the patient to a bankruptcy attorney
Correct answer: Screen the patient for Medicaid eligibility retroactive to the date of service
Retroactive Medicaid eligibility screening is the first step for uninsured patients facing emergency services, as it may cover the entire bill.
Question 2: Under EMTALA, a hospital's financial counseling obligations regarding patients seeking emergency care include:
- Collecting a co-pay before the medical screening exam
- Discussing payment options only after the patient is stabilized (Correct answer)
- Requiring pre-authorization from an insurer before treatment
- Obtaining a signed financial agreement before triage
Correct answer: Discussing payment options only after the patient is stabilized
EMTALA prohibits delaying the medical screening exam for financial reasons; financial counseling occurs after the patient is medically stabilized.
Question 3: A financial counselor is calculating a patient's estimated out-of-pocket cost. The patient has met $1,200 of a $3,000 annual deductible and has a 20% coinsurance with a $6,000 out-of-pocket maximum. The planned procedure costs $8,000. What is the patient's estimated liability?
- $1,600
- $3,360
- $2,960 (Correct answer)
- $1,800
Correct answer: $2,960
Remaining deductible is $1,800; after deductible, 20% coinsurance on $6,200 = $1,240; but the OOP cap is $6,000, so total patient liability from the OOP perspective is $1,800 + $1,160 = $2,960.
Question 4: Which federal law requires hospitals to provide patients with a 'Good Faith Estimate' of expected charges before a scheduled service?
- HIPAA
- The No Surprises Act (Correct answer)
- The Affordable Care Act
- COBRA
Correct answer: The No Surprises Act
The No Surprises Act, effective January 2022, requires providers to give uninsured and self-pay patients a Good Faith Estimate at least three business days before a scheduled service.
Question 5: A patient declines a payment plan and states they cannot afford any portion of their $2,500 balance. The most appropriate next action for the financial counselor is to:
- Immediately send the account to collections
- Document the refusal and close the account
- Screen the patient for charity care or financial assistance eligibility (Correct answer)
- Require the patient to sign a promissory note
Correct answer: Screen the patient for charity care or financial assistance eligibility
Financial counselors must offer charity care screening before escalating to collections, as many patients who decline payment plans may qualify for assistance.
Question 6: When a patient has both Medicare Part A and a Medigap (supplemental) policy, the financial counselor should understand that Medigap typically covers:
- Prescription drug costs under Part D
- Medicare Part A deductibles and coinsurance (Correct answer)
- Non-covered cosmetic services
- Medicare Advantage premiums
Correct answer: Medicare Part A deductibles and coinsurance
Medigap policies are designed to fill gaps in Original Medicare, including Part A deductibles and coinsurance amounts not covered by Medicare.
Question 7: A financial counselor is assisting a patient who received an Explanation of Benefits (EOB) showing a claim was denied as 'not medically necessary.' The best immediate action is to:
- Write off the balance as bad debt
- Advise the patient to pay the full billed amount immediately
- Coordinate with the clinical team to gather supporting documentation for an appeal (Correct answer)
- Transfer the account to self-pay and offer a prompt-pay discount
Correct answer: Coordinate with the clinical team to gather supporting documentation for an appeal
Medical necessity denials are commonly overturned on appeal when clinical documentation supporting the need for the service is submitted to the payer.
CRCR Financial Counseling and Patient Financial Services 4
A patient is uninsured and requires emergency surgery costing $45,000.
Which financial assistance program should the financial counselor explore FIRST?