CRCR Financial Counseling and Patient Financial Services 4

Question 1

A patient is uninsured and requires emergency surgery costing $45,000. Which financial assistance program should the financial counselor explore FIRST?

Accepted Answer

Screen the patient for Medicaid eligibility retroactive to the date of service

Answer

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:

Accepted Answer

Discussing payment options only after the patient is stabilized

Answer

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?

Accepted Answer

$2,960

Answer

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?

Accepted Answer

The No Surprises Act

Answer

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:

Accepted Answer

Screen the patient for charity care or financial assistance eligibility

Answer

Financial counselors must offer charity care screening before escalating to collections, as many patients who decline payment plans may qualify for assistance.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR Financial Counseling and Patient Financial Services 4