HFMA CRCR TEST PREP COMPREHENSIVE
STUDY PAPER WITH FULLY SOLVED QUESTIONS
AND ANSWERS
◍ Customer Experience - 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 - HFMA revenue cycle initiatives:
Patients Financial communications best practices
Best practice for price transparency
medical account resolution
◍ Financial Discussions - In ED Setting - no patient financial
discussions should occur before a patient is screened and stabilized, in
accordance with local regulations governing the ed.
◍ Emergency med conditions - If medical screening determines that a
patient has an emergency med condition, the financial discussion should
occur during the discharge process.
,For patients who do not have emergency condition following the
medical screening, discussion may occur during registration at bedside
or discharge process.
◍ Non-emergency conditions - Outside ED Setting discussions may take
place during registration or discharge process in a location that does not
disrupt patient flow.
If a patient consents to financial discussion during a medical encounter
to expedite discharge, best practice supports that choice.
◍ Discussions in advance of service - Use the most appropriate means
of communication for the patient, can occur via outbound contact with
the patient, inbound contact from the patient, or scheduling contact at
time of appointment.
◍ Timeliness of discussion - Reasonable attempt must be made to have
the discussion as early as possible, before financial obligation is incurred
(service)
◍ Patients - Patients should be given the opportunity to request a patient
advocate, family member. Or other designee to help them with
discussion.
◍ Provision of Care - ED Patients should also be informed that their
ability to pay will not interfere with treatment of any emergency medical
conditions.
,Uninsured patients - should be informed that the goal of collecting info.
Is to identify paying solutions or financial assistance options that may
aid them with their financial obligations.
OON - must be provided disclosures, notifications and consent
according to fed/state regulations.
◍ Prior balances - Across all lines - it is important to have clear policies
on how to interact with patients with prior balances. Providers should
have clear definitions of elective and non-elective procedures. Policies
should be made available to public.
Patients should be informed for non-elective surgeries of that their
ability to resolve prior balances with not affect provision of care.
Prior to elective - patient should do good faith estimate within state/fed
regulations to make payment arrangements.
◍ Annual Financial Training Programs - Must include:
Patient financial communications specific to staff role
Financial assistance policies
Available patient financing options.
Alternative solutions for the uninsured
Standard language to be used
Laws and regulations.
, ◍ Annual observation - Observation, monitoring and tracking of results
make up the process of compliance evaluation required to document
compliance.
◍ Evaluation of technology - Ensuring that:
Insurance eligibility for current services
Existing prior balance for current services
Estimated cost of current services and patient responsibility portion.
◍ Cost of poor quality patient experiences - Loss of future revenue
Soft cost - customers passing on info about their negative experience to
those they know and social media.
◍ Quality - Nearly 40% of billing information is obtained during the
registration process.
◍ Registration staff - Are the key customer service reps of the org. They
should orient the patient to financial procedures and be a resource for
questions and concerns.
◍ Patient accounting dept. - Is charged with the responsibility of
account resolutions. They: modify bill formats and statements, extend
Normal business hours for patient inquiries, make sure staff answer the
telephone courteously. Give patient their names.
STUDY PAPER WITH FULLY SOLVED QUESTIONS
AND ANSWERS
◍ Customer Experience - 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 - HFMA revenue cycle initiatives:
Patients Financial communications best practices
Best practice for price transparency
medical account resolution
◍ Financial Discussions - In ED Setting - no patient financial
discussions should occur before a patient is screened and stabilized, in
accordance with local regulations governing the ed.
◍ Emergency med conditions - If medical screening determines that a
patient has an emergency med condition, the financial discussion should
occur during the discharge process.
,For patients who do not have emergency condition following the
medical screening, discussion may occur during registration at bedside
or discharge process.
◍ Non-emergency conditions - Outside ED Setting discussions may take
place during registration or discharge process in a location that does not
disrupt patient flow.
If a patient consents to financial discussion during a medical encounter
to expedite discharge, best practice supports that choice.
◍ Discussions in advance of service - Use the most appropriate means
of communication for the patient, can occur via outbound contact with
the patient, inbound contact from the patient, or scheduling contact at
time of appointment.
◍ Timeliness of discussion - Reasonable attempt must be made to have
the discussion as early as possible, before financial obligation is incurred
(service)
◍ Patients - Patients should be given the opportunity to request a patient
advocate, family member. Or other designee to help them with
discussion.
◍ Provision of Care - ED Patients should also be informed that their
ability to pay will not interfere with treatment of any emergency medical
conditions.
,Uninsured patients - should be informed that the goal of collecting info.
Is to identify paying solutions or financial assistance options that may
aid them with their financial obligations.
OON - must be provided disclosures, notifications and consent
according to fed/state regulations.
◍ Prior balances - Across all lines - it is important to have clear policies
on how to interact with patients with prior balances. Providers should
have clear definitions of elective and non-elective procedures. Policies
should be made available to public.
Patients should be informed for non-elective surgeries of that their
ability to resolve prior balances with not affect provision of care.
Prior to elective - patient should do good faith estimate within state/fed
regulations to make payment arrangements.
◍ Annual Financial Training Programs - Must include:
Patient financial communications specific to staff role
Financial assistance policies
Available patient financing options.
Alternative solutions for the uninsured
Standard language to be used
Laws and regulations.
, ◍ Annual observation - Observation, monitoring and tracking of results
make up the process of compliance evaluation required to document
compliance.
◍ Evaluation of technology - Ensuring that:
Insurance eligibility for current services
Existing prior balance for current services
Estimated cost of current services and patient responsibility portion.
◍ Cost of poor quality patient experiences - Loss of future revenue
Soft cost - customers passing on info about their negative experience to
those they know and social media.
◍ Quality - Nearly 40% of billing information is obtained during the
registration process.
◍ Registration staff - Are the key customer service reps of the org. They
should orient the patient to financial procedures and be a resource for
questions and concerns.
◍ Patient accounting dept. - Is charged with the responsibility of
account resolutions. They: modify bill formats and statements, extend
Normal business hours for patient inquiries, make sure staff answer the
telephone courteously. Give patient their names.
