CRCR Patient Access and Registration 4 — Questions and Answers
Question 1: A patient presents with an insurance card from a plan that is not contracted with the hospital. The registrar's first step should be to:
- Refuse registration and direct the patient to an in-network facility
- Inform the patient of the out-of-network status and discuss self-pay or financial assistance options (Correct answer)
- Register as in-network and adjust the claim later
- Contact the payer to request retroactive in-network status
Correct answer: Inform the patient of the out-of-network status and discuss self-pay or financial assistance options
Transparency at registration ensures the patient understands their financial responsibility; financial assistance or payment options should be presented before care is provided.
Question 2: The 'two-patient identifier' protocol used during registration requires staff to verify which combination?
- Date of birth and room number
- Patient name and at least one additional unique identifier such as date of birth or medical record number (Correct answer)
- Insurance ID and employer name
- Social Security Number and address
Correct answer: Patient name and at least one additional unique identifier such as date of birth or medical record number
The Joint Commission requires at least two patient-specific identifiers (commonly name plus DOB or MRN) to prevent patient identification errors and ensure safe care.
Question 3: When a minor presents for treatment without a parent or guardian, registration staff should:
- Always refuse treatment until a guardian is present
- Treat the minor for emergency care and attempt to contact the guardian; for non-emergencies, follow state law on consent (Correct answer)
- Obtain consent from any adult accompanying the minor
- Document that consent was waived and proceed regardless of situation
Correct answer: Treat the minor for emergency care and attempt to contact the guardian; for non-emergencies, follow state law on consent
Emergency care for minors can proceed without parental consent; non-emergency treatment requires verification of consent authority under applicable state law.
Question 4: Which Medicare coverage part specifically covers inpatient hospital stays, skilled nursing facilities, and hospice care?
- Medicare Part B
- Medicare Part C
- Medicare Part A (Correct answer)
- Medicare Part D
Correct answer: Medicare Part A
Medicare Part A covers inpatient hospital care, skilled nursing facility stays, hospice, and some home health services after meeting deductible requirements.
Question 5: A registrar discovers mid-registration that the patient had a prior visit under a different medical record number. The BEST action is to:
- Complete registration under the new number and ignore the duplicate
- Flag the duplicate for a medical record merge according to facility policy (Correct answer)
- Delete the older record immediately
- Ask the patient which record number they prefer
Correct answer: Flag the duplicate for a medical record merge according to facility policy
Duplicate medical records pose patient safety risks; facilities have defined processes for overlapping and merging records that must be followed by HIM or registration leadership.
Question 6: What is the primary goal of a charity care screening conducted during patient access?
- To qualify patients for government insurance retroactively
- To identify patients who may qualify for free or reduced-cost care based on financial need (Correct answer)
- To delay collection activity until the account ages to 90 days
- To convert self-pay patients to Medicaid automatically
Correct answer: To identify patients who may qualify for free or reduced-cost care based on financial need
Charity care screening during registration identifies financially disadvantaged patients early so appropriate assistance can be arranged before or after service.
Question 7: A payer requires a referral from the patient's primary care physician (PCP) before covering a specialist visit. This requirement is characteristic of which plan type?
- Preferred Provider Organization (PPO)
- Health Maintenance Organization (HMO) (Correct answer)
- Indemnity plan
- High-Deductible Health Plan (HDHP)
Correct answer: Health Maintenance Organization (HMO)
HMO plans typically require members to select a PCP and obtain referrals for specialist services; PPOs and indemnity plans generally do not have this requirement.
CRCR Patient Access and Registration 4
A patient presents with an insurance card from a plan that is not contracted with the hospital.
The registrar's first step should be to: