CRCR Patient Access and Registration 5 — Questions and Answers
Question 1: A patient scheduled for a same-day surgery is found to lack the required pre-authorization. The registrar should:
- Proceed with the surgery and request authorization retroactively
- Notify the surgeon and authorization team immediately so authorization can be obtained or the case rescheduled (Correct answer)
- Cancel the case without notifying the surgical team
- Collect a cash deposit equal to the full charge and proceed
Correct answer: Notify the surgeon and authorization team immediately so authorization can be obtained or the case rescheduled
Timely notification allows the clinical and authorization teams to obtain approval or make an informed decision about rescheduling, protecting the patient and the facility's reimbursement.
Question 2: Which of the following BEST describes 'insurance portability' as it relates to HIPAA?
- Patients can transfer their insurance plan to any facility
- Employees can maintain continuous health coverage when changing jobs without being denied due to pre-existing conditions (Correct answer)
- Insurers can port patient data between databases freely
- Patients can move their deductible credits between plan years
Correct answer: Employees can maintain continuous health coverage when changing jobs without being denied due to pre-existing conditions
The portability provisions of HIPAA protect workers from losing health coverage due to pre-existing conditions when transitioning between employer-sponsored health plans.
Question 3: A patient's insurance requires a $50 copay at time of service. The patient says they will pay on the way out. Best practice dictates the registrar should:
- Accept the patient's statement and note it for billing
- Collect the copay before or at the time of the encounter per facility policy (Correct answer)
- Waive the copay to avoid patient dissatisfaction
- Bill the copay to secondary insurance instead
Correct answer: Collect the copay before or at the time of the encounter per facility policy
Point-of-service copay collection is standard best practice and reduces the cost of downstream billing and collections; consistent collection also satisfies payer contract requirements.
Question 4: When verifying a Medicaid patient's eligibility, the registrar learns coverage ended the previous month. The appropriate next step is to:
- Register the patient as Medicaid-covered and hope it was an error
- Inform the patient of the lapse and screen for Medicaid reinstatement or other financial assistance (Correct answer)
- Deny service immediately
- Call the state Medicaid office on the patient's behalf to reinstate coverage during registration
Correct answer: Inform the patient of the lapse and screen for Medicaid reinstatement or other financial assistance
A coverage lapse requires immediate patient notification and financial counseling to explore reinstatement, other coverage, or charity care options before or after service.
Question 5: Which of the following is considered a 'front-end' revenue cycle function directly performed by the patient access team?
- Posting insurance payments to patient accounts
- Verifying insurance eligibility prior to the patient visit (Correct answer)
- Appealing denied claims with clinical documentation
- Generating an itemized bill after discharge
Correct answer: Verifying insurance eligibility prior to the patient visit
Eligibility verification is a pre-service, front-end function; payment posting and denial appeals are mid- and back-end revenue cycle activities.
Question 6: A guarantor is BEST defined as:
- The insurance company responsible for primary payment
- The individual financially responsible for the patient's account (Correct answer)
- The patient's primary care physician
- The hospital's collections vendor
Correct answer: The individual financially responsible for the patient's account
The guarantor is the person legally responsible for paying the account, which may be the patient, a parent, a spouse, or another designated individual.
Question 7: During a scheduled pre-registration call, the patient reports a change in their employer and insurance plan. The registrar must:
- Update the insurance on the account only after the visit is completed
- Update the account immediately and re-verify eligibility and benefits under the new plan (Correct answer)
- Keep the old insurance on file as a backup without making changes
- Advise the patient to bring proof of new insurance on the day of service only
Correct answer: Update the account immediately and re-verify eligibility and benefits under the new plan
Timely account updates and re-verification prevent claim denials caused by billing an outdated or inactive plan and ensure authorization requirements for the new plan are met.
CRCR Patient Access and Registration 5
A patient scheduled for a same-day surgery is found to lack the required pre-authorization.
The registrar should: