CRCR Study Questions and Answers 2023-2024 100%
Solved
Pre-Service (Step 1) - ANS-1. The patient is scheduled and pre-registered for service
Pre-Service (Step 2) - ANS-2. The encounter record is generated, and the patient and guarantor
information is obtained and/or updated as required.
Pre-Service (Step 3) - ANS-3. The requested service is screened for medical necessity; health plan
coverage and benefits are verified, and pre-authorizations are obtained.
Pre-Service (Step 4) - ANS-4. The cost of the scheduled service is identified and the patient's health plan
and benefits are used to calculate the price of the services to the patient.
This price typically includes a deductible, coinsurance and/or copayment amounts.
If the service is identified as "not medically necessary," additional processing is required.
Pre-Service (Step 5) - ANS-5. The patient is notified of their financial responsibility including copayments
and health plan deductibles, and their eligibility for financial assistance is assessed.
Time of Service (steps) - ANS-1. For scheduled patients, a final account review is completed prior to the
patient's arrival.
Ideally, the scheduled patient arrives at the service unit where the pre-registration record is activated,
consents are signed, and co-payments and/or other agreed upon amounts are collected.
Positive patient identification is completed, and the patient is given an armband which corresponds to
the activated account number.
Alternatively, scheduled, pre-processed patients can report to a designated "express arrival" desk
located in a centralized access area upon their arrival.
Time of Service (steps) - ANS-2. For unscheduled patients, comprehensive registration and financial
processing is completed at the time-of-service. This process mirrors the work that was completed for
the scheduled patients prior to service.
,Post-Service - ANS-Post-service includes the account activities that occur after the patient is discharged
until the account reaches a zero balance, such as final coding of all services provided, preparation and
submission of claims, payment processing and balance billing and resolution, as appropriate.
Healthcare Dollars & Sense Pillars - ANS-1. Patient financial communications best practices
2. Best practices for price transparency
3. Medical account resolution
Dollars & Sense (Patient Financial Communication) - ANS-These common-sense best practices bring
consistency, clarity, and transparency to patient financial communications by outlining steps to help
patients understand the cost of services they receive, their insurance coverage, and their individual
responsibility.
Dollars & Sense Time of Service Discussion - ANS-The best practices specify that in the ED setting, no
patient financial discussions should occur before a patient is screened and stabilized, in accordance with
the local regulations governing the ED.
Dollars & Sense Emergency Medical Condition - ANS-If the medical screening determines that a patient
has an emergency medical condition, the financial discussion should occur during the discharge process.
For patients who do not have an emergency medical condition, following the medical screening,
discussion may occur during either the registration or discharge process.
Dollars & Sense Non-emergency Conditions - ANS-Outside the ED setting, discussions may take place
during the registration or discharge process in a location that does not disrupt patient flow.
Across all care settings, if a patient consents to a financial discussion during a medical encounter to
expedite discharge, the best practices support that choice, providing that the discussion does not
interfere with patient care or disrupt patient flow.
Dollars & Sense Discussions in Advance of Service - ANS-Discussions should use the most appropriate
means of communication for the patient, and may occur via outbound contact to the patient, inbound
contact from patients making inquiries, or through the scheduling or contact center at the time an
appointment is made.
, Dollars & Sense Timeliness of Discussions - ANS-The best practices stipulate that a reasonable attempt
should be made to have the discussion as early as possible, before a financial obligation is incurred (i.e.,
before care is provided).
Timely discussions help ensure that patients understand their financial obligation and that providers are
aware of the patient's ability to pay and/or the source of payment.
Dollars & Sense Routine Scenario - ANS-For routine scenarios, such as patients with insurance coverage
or a known ability to pay, financial discussions should take place between the patient or guarantor (i.e.,
the person responsible for payment of the bill) and properly trained provider representatives.
Dollars & Sense Complex Scenario - ANS-For non-routine or complex scenarios, such as uninsured or
underinsured patients, a financial counselor or supervisor should be involved.
Dollars & Sense Financial Discussion - ANS-The practices detail typical elements of patient financial
discussions, including provision of care, registration, insurance verification, and financial counseling (i.e.
patient share, prior balances (if applicable), and balance resolution).
Dollars & Sense Financial Counseling - ANS-Recognizing that health coverage is complicated and not all
patients are well equipped to navigate this terrain, the best practices specify that patients should be
given the opportunity to request a patient advocate, family member, or other designee to help them in
these discussions.
Price Transparency - ANS-Patients are contacting hospitals to proactively inquire about costs and fees
prior to agreeing to service.The problem is that charge master lists the total charge, not net charges that
reflect charges after a payer's contractual adjustment. In order to provide a patient with information
that is meaningful to them, several factors must be included:
The type of hospital service based on CPT or MS-DRG code.
The patient's health plan.
The patient's benefit plan
ACA - Association of Credit & Collections Professionals - ANS-HFMA partnered with ACA (NOT the
Affordable Care Act) , the Association of Credit and Collections Professionals International, and brought
together provider organizations, our business partners in the collection agencies, and patient advocates
to form the medical debt task force. This group developed a best practice workflow that builds off of
Solved
Pre-Service (Step 1) - ANS-1. The patient is scheduled and pre-registered for service
Pre-Service (Step 2) - ANS-2. The encounter record is generated, and the patient and guarantor
information is obtained and/or updated as required.
Pre-Service (Step 3) - ANS-3. The requested service is screened for medical necessity; health plan
coverage and benefits are verified, and pre-authorizations are obtained.
Pre-Service (Step 4) - ANS-4. The cost of the scheduled service is identified and the patient's health plan
and benefits are used to calculate the price of the services to the patient.
This price typically includes a deductible, coinsurance and/or copayment amounts.
If the service is identified as "not medically necessary," additional processing is required.
Pre-Service (Step 5) - ANS-5. The patient is notified of their financial responsibility including copayments
and health plan deductibles, and their eligibility for financial assistance is assessed.
Time of Service (steps) - ANS-1. For scheduled patients, a final account review is completed prior to the
patient's arrival.
Ideally, the scheduled patient arrives at the service unit where the pre-registration record is activated,
consents are signed, and co-payments and/or other agreed upon amounts are collected.
Positive patient identification is completed, and the patient is given an armband which corresponds to
the activated account number.
Alternatively, scheduled, pre-processed patients can report to a designated "express arrival" desk
located in a centralized access area upon their arrival.
Time of Service (steps) - ANS-2. For unscheduled patients, comprehensive registration and financial
processing is completed at the time-of-service. This process mirrors the work that was completed for
the scheduled patients prior to service.
,Post-Service - ANS-Post-service includes the account activities that occur after the patient is discharged
until the account reaches a zero balance, such as final coding of all services provided, preparation and
submission of claims, payment processing and balance billing and resolution, as appropriate.
Healthcare Dollars & Sense Pillars - ANS-1. Patient financial communications best practices
2. Best practices for price transparency
3. Medical account resolution
Dollars & Sense (Patient Financial Communication) - ANS-These common-sense best practices bring
consistency, clarity, and transparency to patient financial communications by outlining steps to help
patients understand the cost of services they receive, their insurance coverage, and their individual
responsibility.
Dollars & Sense Time of Service Discussion - ANS-The best practices specify that in the ED setting, no
patient financial discussions should occur before a patient is screened and stabilized, in accordance with
the local regulations governing the ED.
Dollars & Sense Emergency Medical Condition - ANS-If the medical screening determines that a patient
has an emergency medical condition, the financial discussion should occur during the discharge process.
For patients who do not have an emergency medical condition, following the medical screening,
discussion may occur during either the registration or discharge process.
Dollars & Sense Non-emergency Conditions - ANS-Outside the ED setting, discussions may take place
during the registration or discharge process in a location that does not disrupt patient flow.
Across all care settings, if a patient consents to a financial discussion during a medical encounter to
expedite discharge, the best practices support that choice, providing that the discussion does not
interfere with patient care or disrupt patient flow.
Dollars & Sense Discussions in Advance of Service - ANS-Discussions should use the most appropriate
means of communication for the patient, and may occur via outbound contact to the patient, inbound
contact from patients making inquiries, or through the scheduling or contact center at the time an
appointment is made.
, Dollars & Sense Timeliness of Discussions - ANS-The best practices stipulate that a reasonable attempt
should be made to have the discussion as early as possible, before a financial obligation is incurred (i.e.,
before care is provided).
Timely discussions help ensure that patients understand their financial obligation and that providers are
aware of the patient's ability to pay and/or the source of payment.
Dollars & Sense Routine Scenario - ANS-For routine scenarios, such as patients with insurance coverage
or a known ability to pay, financial discussions should take place between the patient or guarantor (i.e.,
the person responsible for payment of the bill) and properly trained provider representatives.
Dollars & Sense Complex Scenario - ANS-For non-routine or complex scenarios, such as uninsured or
underinsured patients, a financial counselor or supervisor should be involved.
Dollars & Sense Financial Discussion - ANS-The practices detail typical elements of patient financial
discussions, including provision of care, registration, insurance verification, and financial counseling (i.e.
patient share, prior balances (if applicable), and balance resolution).
Dollars & Sense Financial Counseling - ANS-Recognizing that health coverage is complicated and not all
patients are well equipped to navigate this terrain, the best practices specify that patients should be
given the opportunity to request a patient advocate, family member, or other designee to help them in
these discussions.
Price Transparency - ANS-Patients are contacting hospitals to proactively inquire about costs and fees
prior to agreeing to service.The problem is that charge master lists the total charge, not net charges that
reflect charges after a payer's contractual adjustment. In order to provide a patient with information
that is meaningful to them, several factors must be included:
The type of hospital service based on CPT or MS-DRG code.
The patient's health plan.
The patient's benefit plan
ACA - Association of Credit & Collections Professionals - ANS-HFMA partnered with ACA (NOT the
Affordable Care Act) , the Association of Credit and Collections Professionals International, and brought
together provider organizations, our business partners in the collection agencies, and patient advocates
to form the medical debt task force. This group developed a best practice workflow that builds off of
