CRCR Patient Access and Front-End Processes 5

Question 1

Which of the following BEST describes the role of the Medical Necessity check in patient access?

Accepted Answer

Ensuring that the ordered service is clinically justified per payer guidelines

Answer

Medical necessity verification confirms that the ordered service meets clinical criteria established by the payer, reducing the likelihood of a medical necessity denial.

Question 2

A patient has both Medicare as primary and a Medicaid plan as secondary. Which coordination of benefits rule applies?

Accepted Answer

Medicare pays first, and Medicaid may cover remaining costs as the payer of last resort

Answer

Medicaid is always the payer of last resort; Medicare pays first, and Medicaid may cover eligible remaining balances after Medicare adjudication.

Question 3

When collecting a point-of-service payment, which is the BEST practice for patient access staff?

Accepted Answer

Use the payer's eligibility response and fee schedule to provide an accurate cost estimate

Answer

Using real-time eligibility data and contracted fee schedules produces the most accurate patient cost estimate, improving collections and patient satisfaction.

Question 4

An outpatient registration form requires a patient signature on a Conditions of Admission. What does this form primarily establish?

Accepted Answer

The patient's agreement to the facility's general terms, including assignment of benefits

Answer

The Conditions of Admission form establishes the patient's consent to treatment, assignment of benefits to the facility, and acknowledgment of financial responsibility policies.

Question 5

What is the PRIMARY purpose of obtaining a signed Assignment of Benefits (AOB) at registration?

Accepted Answer

To allow the hospital to bill the payer directly and receive reimbursement on the patient's behalf

Answer

The Assignment of Benefits authorizes the insurance payer to send payment directly to the provider rather than to the patient.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR Patient Access and Front-End Processes 5