CRCR Certification Exam Actual Questions with
Revised Answers 100% Correct
CDHP (Consumer Directed Health Plan) - ANSWER -Specific set of health
insurance arrangements in which individuals have a high-deductible health plan
coupled with a personal health account (PHA) that they can use to pay health care
expenses not covered by insurance. A High Deductible Health Plan (HDHP) is an
example of a consumer directed health plan (CDHP).
Managed Care Health Plans Use the following tools and procedures: - ANSWER -
1) Pre-certification/Pre-authorization
2) Referrals
3) Notification
4) Site-of-Service Limitations
5) Case Management
6) Discharge Planning
The two components of price determination: - ANSWER -1) The first component
of a pricing determination is a verification of the patient's insurance eligibility and
benefits.
2) To identify the service or test involved.
The clinical information needed to determine a price includes:
-Service(s) or test(s)
-Patient type
-Diagnosis and procedure codes
-Any anticipated follow-up care
Providing a estimate for uninsured patient: - ANSWER -1. Verify that the patient
is not eligible for Medicaid or financial assistance under your organization's
financial assistance policy (FAP).
2. Obtain the total charges for the hospital portion of the case; concurrently
identify any additional providers who may be involved (anesthesia, etc.) and note
their in-network or out-of-network status.
,3. Apply your organization's self-pay discount and financial assistance adjustment,
if applicable.
4. Share the results with the patient and explain the discount applied.
5. Come to a financial resolution with the patient and document the resolution in
the patient's record.
3 Steps of constructing a price estimate: - ANSWER -1) Verify insurance
coverage
2) Identify the contract terms between organization and health plan
3) Obtain the total charges of hospital portion of case
Sequential order of financial counseling steps - ANSWER -1) Greet patient and
give name
2) Explain organization financial care approach and patient financial responsibility
3) Review patients health plan and status
4) Review anticipated charges and patients liability
5) Ask patient to resolve liability by reviewing options
6) For uninsured, explain financial assistance options
The categories of information on the application form that assess the patients
financial status: - ANSWER -1) Demographic
2) Income
3) Assets
4) Expenses
EMTALA (Emergency Medical Treatment and Active Labor Act) - ANSWER -
Prevent the transfer of unstable patients between care facilities solely for economic
purposes.
Discharge process - ANSWER -Step 1
The physician must write the discharge order.
Step 2
Case management discharge planning must be finalized.
Step 3
Appropriate discharge instructions must be provided to the patient.
, Step 4
Access services must review the patient's record to see if the patient qualifies for
courtesy discharge, and if not, notification must be sent for the patient to see a
financial counselor prior to discharge.
Step 5
When the patient leaves, the registration system must be updated to reflect the
correct date and time of discharge, and the correct disposition code (e.g., home,
nursing home, SNF, another acute facility, rehab).
Purpose of Case Management - ANSWER -The purpose of case management is to
monitor the progression of high resource consumptive cases to help ensure
effective utilization of resources during the care of the patient and maximize
patient outcomes.
Types of Case Management Reviews - ANSWER -1) Prospective review (pre-
certification) - before service
2) Concurrent review and discharge planning - during service
3) Retrospective review - after service
When does discharge planning start and what does it include? - ANSWER -
Discharge planning starts as soon as a patient is admitted into the facility, or even
before.
This planning includes:
- An estimate of how long the patient will be in the hospital.
- What the expected outcome will be.
- Whether there will be any special requirements on discharge.
- What needs to be facilitated to effectively discharge the patient in an
appropriately timely manner.
Case Manager Responsibilities - ANSWER -The case manager is responsible for:
1) Coordinating patient care and helping to ensure the patient is moved from one
point in the care process to the next point in the process.
2) Routine contact with the health plan or liability payer, making sure all required
information is provided and all needed approvals are obtained.
Revised Answers 100% Correct
CDHP (Consumer Directed Health Plan) - ANSWER -Specific set of health
insurance arrangements in which individuals have a high-deductible health plan
coupled with a personal health account (PHA) that they can use to pay health care
expenses not covered by insurance. A High Deductible Health Plan (HDHP) is an
example of a consumer directed health plan (CDHP).
Managed Care Health Plans Use the following tools and procedures: - ANSWER -
1) Pre-certification/Pre-authorization
2) Referrals
3) Notification
4) Site-of-Service Limitations
5) Case Management
6) Discharge Planning
The two components of price determination: - ANSWER -1) The first component
of a pricing determination is a verification of the patient's insurance eligibility and
benefits.
2) To identify the service or test involved.
The clinical information needed to determine a price includes:
-Service(s) or test(s)
-Patient type
-Diagnosis and procedure codes
-Any anticipated follow-up care
Providing a estimate for uninsured patient: - ANSWER -1. Verify that the patient
is not eligible for Medicaid or financial assistance under your organization's
financial assistance policy (FAP).
2. Obtain the total charges for the hospital portion of the case; concurrently
identify any additional providers who may be involved (anesthesia, etc.) and note
their in-network or out-of-network status.
,3. Apply your organization's self-pay discount and financial assistance adjustment,
if applicable.
4. Share the results with the patient and explain the discount applied.
5. Come to a financial resolution with the patient and document the resolution in
the patient's record.
3 Steps of constructing a price estimate: - ANSWER -1) Verify insurance
coverage
2) Identify the contract terms between organization and health plan
3) Obtain the total charges of hospital portion of case
Sequential order of financial counseling steps - ANSWER -1) Greet patient and
give name
2) Explain organization financial care approach and patient financial responsibility
3) Review patients health plan and status
4) Review anticipated charges and patients liability
5) Ask patient to resolve liability by reviewing options
6) For uninsured, explain financial assistance options
The categories of information on the application form that assess the patients
financial status: - ANSWER -1) Demographic
2) Income
3) Assets
4) Expenses
EMTALA (Emergency Medical Treatment and Active Labor Act) - ANSWER -
Prevent the transfer of unstable patients between care facilities solely for economic
purposes.
Discharge process - ANSWER -Step 1
The physician must write the discharge order.
Step 2
Case management discharge planning must be finalized.
Step 3
Appropriate discharge instructions must be provided to the patient.
, Step 4
Access services must review the patient's record to see if the patient qualifies for
courtesy discharge, and if not, notification must be sent for the patient to see a
financial counselor prior to discharge.
Step 5
When the patient leaves, the registration system must be updated to reflect the
correct date and time of discharge, and the correct disposition code (e.g., home,
nursing home, SNF, another acute facility, rehab).
Purpose of Case Management - ANSWER -The purpose of case management is to
monitor the progression of high resource consumptive cases to help ensure
effective utilization of resources during the care of the patient and maximize
patient outcomes.
Types of Case Management Reviews - ANSWER -1) Prospective review (pre-
certification) - before service
2) Concurrent review and discharge planning - during service
3) Retrospective review - after service
When does discharge planning start and what does it include? - ANSWER -
Discharge planning starts as soon as a patient is admitted into the facility, or even
before.
This planning includes:
- An estimate of how long the patient will be in the hospital.
- What the expected outcome will be.
- Whether there will be any special requirements on discharge.
- What needs to be facilitated to effectively discharge the patient in an
appropriately timely manner.
Case Manager Responsibilities - ANSWER -The case manager is responsible for:
1) Coordinating patient care and helping to ensure the patient is moved from one
point in the care process to the next point in the process.
2) Routine contact with the health plan or liability payer, making sure all required
information is provided and all needed approvals are obtained.
