CRCR EXAM MULTIPLE CHOICE, CRCR Exam Prep, Certified Revenue Cycle Representative

CRCR EXAM MULTIPLE CHOICE, CRCR Exam Prep, Certified Revenue Cycle Representative Revenue Cycle - ANS All of the major processing steps required to process a patient account from the request for service through closing the account with a zero balance and purging it from the system. Pre-Service - ANS 1. Patient is scheduled and registered for service 2. Patient Service cost is calculated Time-of-Servce - ANS 1. Case Management and Discharge Plans are provided 2. Consent forms are signed Post-Service - ANS 1. Bills are sent electronically to health plan 2. Patient account is monitored for payment Pre-Service activities - ANS 1. Requested service is screened for med necessity, health coverage/benefits verified, preauthorization obtained and estimate to patient oop costs generated within guidelines of NSA and state regulations. 2. Patient notified of financial responsibility including copayment and health plan deductibles, eligibility of financial assistance assessed. 3. Patient is scheduled 4. Encounter record is generated and patient and guarantor info is obtained and updates as part of preregistration. 5. Cost of the scheduled service identified patients health plan benefits are used to calculate the price of the services to the patient. - includes deductible, coinsurance and or copayment amounts. Time of service - ANS Financial account review is completed prior to patient visit. Patient arrives at service unit where pre-registration record is activated, consents are signed, copayments and agreed upon amounts are collected. Positive identification is completed, and the patient is given an armband with acct number. Scheduled preprocessed patients report to designated express arrival desk located in centralized area upon arrival. Unscheduled patients - Time of Service - ANS Comprehensive registration and financial processing is completed at time of service. Mirroring scheduled patients who is OON with provider furnishing services during their encounter all federal and state transparency and NSA provisions are followed to provide consent to patient of their rights Time of Service steps - ANS Case management and discharge planning are provided. Orders are entered. Results are reported. Charges are generated. Diagnostic and procedural coding is completed. ONGOING: Monitor of charges Managed care resolution Patient liabilities resolution, as needed. Ensure health plan requirements and liability calculations change - vet the changes against fed/state guidelines. Consent and updated estimates are communicated to patient and health plan. Post Service - ANS Includes the account activities that occur after the patient is discharged until the acct reaches zero balance, such as final coding of all services, preparation and submission of claims, payment processing and balance billing and resolution. Best practices recognize all three critical segments of the contemporary revenue cycle. Each segment includes a series of processes which are specifically designed to ensure accurate data collection, consistent quality, and a high level of patient satisfaction. Preservice - patient is scheduled and registered for service. Patients service costs are calculated. Time of service - Case mgmt and discharge planing services are provided. Consents are signed. Post Service - Bill sent electronically to - ANS Consumer Experience - ANS Each segment of the revenue cycle interacts involving patients. The key to success is establishing a clear and ever present focus on the patient. Patient Experience - ANS Patients are demanding info and choices. Regulations are demanding price transparency. For all known charges - even those not employed by the provider. Expect quality - health care and financial care. Health plans care about quality - HCACPS stars is a measure of satisfaction. With poor scores - Medicare will be reduced. Customer Experience - ANS Customer service is paramount. Empowering front line staff to provide patient focused solutions is basic component of great patient experience. Best practice communication strategies, scripting and training are good tactics. Healthcare Dollars and Sense - ANS HFMA revenue cycle initiatives: Patients Financial communications best practices Best practice for price transparency medical account resolution