CRCR Patient Access and Registration 2 — Questions and Answers
Question 1: A patient arrives for a scheduled outpatient procedure and cannot produce their insurance card. What is the BEST first action for the registrar?
- Refuse service until the card is presented
- Call the insurer directly to verify eligibility using the patient's member ID from the system (Correct answer)
- Proceed with registration as self-pay and bill the patient
- Postpone the procedure until the next available appointment
Correct answer: Call the insurer directly to verify eligibility using the patient's member ID from the system
Registrars should use available member IDs or real-time eligibility tools to verify coverage when a physical card is unavailable, avoiding unnecessary service disruption.
Question 2: Which document notifies Medicare beneficiaries that a service may not be covered and requires their financial responsibility acknowledgment?
- Notice of Privacy Practices (NPP)
- Advance Beneficiary Notice of Noncoverage (ABN) (Correct answer)
- Explanation of Benefits (EOB)
- Certificate of Medical Necessity (CMN)
Correct answer: Advance Beneficiary Notice of Noncoverage (ABN)
The ABN must be issued before providing a potentially non-covered service so the Medicare patient can make an informed decision and accepts financial liability.
Question 3: When a patient has both a primary and secondary insurance, the registration team's coordination of benefits (COB) process should do which of the following?
- Bill only the primary insurer to simplify claims
- Identify the correct payer order and document it in the account (Correct answer)
- Allow the patient to choose which insurer pays first
- Delay secondary billing until primary pays in full automatically
Correct answer: Identify the correct payer order and document it in the account
Proper COB documentation ensures claims are filed to payers in the correct order, maximizing reimbursement and avoiding denials.
Question 4: A new patient presents to the ED with no ID and is unconscious. Under HIPAA, the hospital may:
- Refuse treatment until identity is confirmed
- Treat the patient and document as much identifying information as possible from available sources (Correct answer)
- Assign a permanent medical record number only after identity is verified
- Contact law enforcement and delay registration until they respond
Correct answer: Treat the patient and document as much identifying information as possible from available sources
HIPAA permits disclosure and treatment when necessary for emergency care; registration staff should document all available identifiers and create a temporary record.
Question 5: Which federal law requires hospitals to provide a medical screening exam and stabilizing treatment regardless of the patient's ability to pay?
- HIPAA
- COBRA
- EMTALA (Correct answer)
- Stark Law
Correct answer: EMTALA
The Emergency Medical Treatment and Labor Act (EMTALA) prohibits patient dumping and requires emergency screening and stabilization for anyone presenting to a participating hospital ED.
Question 6: Real-time eligibility (RTE) verification tools are primarily used during patient access to:
- Submit claims electronically to payers
- Confirm active coverage and benefit details before service is rendered (Correct answer)
- Generate patient statements after discharge
- Validate diagnosis codes against procedure codes
Correct answer: Confirm active coverage and benefit details before service is rendered
RTE tools query payer databases to confirm current coverage, deductible balances, copay amounts, and benefit limits at or before the point of service.
Question 7: A registrar incorrectly enters a patient's date of birth, causing a claim denial. This is an example of which type of error?
- Medical necessity denial
- Demographic/data entry error (Correct answer)
- Authorization failure
- Coordination of benefits conflict
Correct answer: Demographic/data entry error
Inaccurate demographic information such as incorrect date of birth is a leading cause of claim denials and is classified as a data entry or front-end registration error.
CRCR Patient Access and Registration 2
A patient arrives for a scheduled outpatient procedure and cannot produce their insurance card.
What is the BEST first action for the registrar?