CRCR Patient Access and Registration 3 — Questions and Answers
Question 1: During pre-registration, a financial counselor determines a patient's estimated out-of-pocket cost is $1,200. The BEST practice is to:
- Wait until after the service to discuss payment
- Collect the full estimated amount before the procedure or set up a payment plan (Correct answer)
- Inform the patient but never collect before service
- Refer the patient immediately to charity care without discussing payment first
Correct answer: Collect the full estimated amount before the procedure or set up a payment plan
Point-of-service collections improve cash flow and reduce bad debt; offering payment plans increases the likelihood of collecting patient-responsible balances.
Question 2: Which government program covers low-income individuals and families, requiring specific eligibility verification during registration?
- Medicare Part A
- Medicaid (Correct answer)
- TRICARE
- CHIP only
Correct answer: Medicaid
Medicaid is a joint federal-state program for low-income populations; eligibility must be verified at each encounter because coverage can change monthly.
Question 3: A patient is being admitted as an inpatient but the physician's order specifies observation status. The registrar should:
- Change the order to inpatient without physician involvement
- Register the patient under the status documented in the physician's order and notify the utilization review team (Correct answer)
- Default to inpatient because it generates higher reimbursement
- Delay registration until the physician rewrites the order as inpatient
Correct answer: Register the patient under the status documented in the physician's order and notify the utilization review team
The registrar must use the physician-documented status and alert utilization review, who can collaborate with the physician on appropriate status determination.
Question 4: The primary purpose of collecting a patient's Social Security Number (SSN) during registration is to:
- Satisfy IRS reporting requirements for all patients
- Assist with identity verification and collections if necessary (Correct answer)
- Submit to Medicare as a required field for all claims
- Share with third-party vendors for credit screening
Correct answer: Assist with identity verification and collections if necessary
SSN collection helps confirm patient identity and supports the collections process; however, it is optional, and patients may decline to provide it.
Question 5: Which type of prior authorization scenario would MOST likely result in a denial if not obtained before the service?
- Routine annual wellness exam under Medicare
- Elective MRI ordered by an in-network specialist (Correct answer)
- Emergency appendectomy performed in the ED
- A preventive colonoscopy for a 50-year-old
Correct answer: Elective MRI ordered by an in-network specialist
Elective non-emergency procedures such as MRIs commonly require prior authorization from the payer; failure to obtain it before service often results in claim denial.
Question 6: Under the HIPAA Privacy Rule, the Notice of Privacy Practices (NPP) must be provided to patients:
- Only upon written request
- At the first service encounter, with a good-faith effort to obtain acknowledgment (Correct answer)
- Annually regardless of whether there have been prior encounters
- Only when a new physician joins the practice
Correct answer: At the first service encounter, with a good-faith effort to obtain acknowledgment
Covered entities must provide the NPP no later than the first service delivery and attempt to obtain the patient's written acknowledgment of receipt.
Question 7: A patient states they have a high-deductible health plan (HDHP) paired with a Health Savings Account (HSA). The registrar should note this because:
- HSA funds cannot be used for hospital services
- The patient likely has a larger patient-responsible balance until the deductible is met (Correct answer)
- HDHP patients are exempt from copay collection
- HSA pairing automatically triggers Medicaid eligibility screening
Correct answer: The patient likely has a larger patient-responsible balance until the deductible is met
HDHP plans carry higher deductibles, meaning patients typically owe more out-of-pocket before insurance pays, which is important for upfront collection conversations.
CRCR Patient Access and Registration 3
During pre-registration, a financial counselor determines a patient's estimated out-of-pocket cost is $1,200.
The BEST practice is to: