CRCR Financial Counseling and Patient Financial Services 5 — Questions and Answers
Question 1: A patient is eligible for both Medicaid and Medicare. In the revenue cycle, this patient is referred to as a:
- Self-pay patient
- Dual-eligible beneficiary (Correct answer)
- Crossover claimant
- Secondary insured
Correct answer: Dual-eligible beneficiary
Patients covered by both Medicare and Medicaid are called dual-eligible beneficiaries; Medicare is billed first and Medicaid serves as the payer of last resort.
Question 2: Which of the following BEST describes the purpose of a financial hardship application in the hospital revenue cycle?
- To qualify patients for government insurance programs
- To determine a patient's eligibility for reduced or waived charges based on income and assets (Correct answer)
- To establish a payment plan based on monthly income
- To identify patients for elective procedure scheduling priority
Correct answer: To determine a patient's eligibility for reduced or waived charges based on income and assets
A financial hardship application assesses a patient's financial situation to determine eligibility for charity care or discounted care programs offered by the hospital.
Question 3: A patient's insurance was terminated one month before a scheduled elective procedure, but the patient did not inform the hospital. The financial counselor discovers this at check-in. The BEST course of action is to:
- Proceed with the procedure and bill the former insurer
- Cancel the procedure immediately without discussion
- Discuss self-pay options, payment plans, and potential assistance programs with the patient before proceeding (Correct answer)
- Require full payment upfront before allowing the procedure
Correct answer: Discuss self-pay options, payment plans, and potential assistance programs with the patient before proceeding
The financial counselor should present all available financial options to the patient so an informed decision can be made about proceeding with the elective service.
Question 4: Under the Affordable Care Act (ACA), non-profit hospitals must meet which requirement related to financial assistance?
- Offer free care to all uninsured patients regardless of income
- Establish and publicize a written Financial Assistance Policy (FAP) (Correct answer)
- Cap all charity care at 50% of billed charges
- Provide interest-free payment plans for all patients with outstanding balances
Correct answer: Establish and publicize a written Financial Assistance Policy (FAP)
Section 501(r) of the Internal Revenue Code, as part of the ACA, requires non-profit hospitals to have a written Financial Assistance Policy that is widely publicized to the community.
Question 5: During financial counseling, a patient indicates they are a veteran. Which resource should the financial counselor consider exploring for coverage of the patient's healthcare costs?
- Indian Health Service (IHS)
- Department of Veterans Affairs (VA) benefits (Correct answer)
- Children's Health Insurance Program (CHIP)
- State Children's Medicaid Waiver
Correct answer: Department of Veterans Affairs (VA) benefits
Veterans may be eligible for VA healthcare benefits that could cover or offset the cost of services received at civilian healthcare facilities.
Question 6: A financial counselor notices that a patient with commercial insurance has a $500 copay due at time of service but is reluctant to pay. Routinely waiving copays for all patients would be considered:
- An acceptable practice if the patient demonstrates financial hardship
- A violation of the insurance contract and potentially fraudulent (Correct answer)
- A standard courtesy that reduces patient dissatisfaction
- Permitted as long as it is not disclosed to the insurer
Correct answer: A violation of the insurance contract and potentially fraudulent
Routinely waiving copays violates the provider's contract with the insurer and may constitute insurance fraud, as it misrepresents the patient's true financial liability.
Question 7: When a patient's account is being considered for transfer to an external collection agency, which action must occur FIRST to comply with hospital financial assistance policy and regulatory requirements?
- Obtain a signed collections consent form from the patient
- Verify that all internal financial assistance options have been exhausted and documented (Correct answer)
- Confirm the patient's current mailing address
- Escalate the account to the CFO for approval
Correct answer: Verify that all internal financial assistance options have been exhausted and documented
Regulatory requirements and best practices mandate that all internal financial assistance options—including charity care screening—be fully exhausted and documented before transferring an account to collections.
CRCR Financial Counseling and Patient Financial Services 5
A patient is eligible for both Medicaid and Medicare.
In the revenue cycle, this patient is referred to as a: