HFMA CRCR TOPICS PREP 2025. | Exam Revision Questions And Correct
Answers | Graded A+ | 2025 Update |
Pre-Service activities - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - ANSWER-
Consumer Experience - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - ANSWER- HFMA revenue cycle initiatives:
Patients Financial communications best practices
Best practice for price transparency
medical account resolution
Financial Discussions - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - ANSWER- Reasonable attempt must be made to have the discussion
as early as possible, before financial obligation is incurred (service)
, Patients - ANSWER- Patients should be given the opportunity to request a patient advocate,
family member. Or other designee to help them with discussion.
Provision of Care - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - ANSWER- Observation, monitoring and tracking of results make up the
process of compliance evaluation required to document compliance.
Evaluation of technology - ANSWER- Ensuring that:
Insurance eligibility for current services
Answers | Graded A+ | 2025 Update |
Pre-Service activities - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - ANSWER-
Consumer Experience - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - ANSWER- HFMA revenue cycle initiatives:
Patients Financial communications best practices
Best practice for price transparency
medical account resolution
Financial Discussions - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - ANSWER- Reasonable attempt must be made to have the discussion
as early as possible, before financial obligation is incurred (service)
, Patients - ANSWER- Patients should be given the opportunity to request a patient advocate,
family member. Or other designee to help them with discussion.
Provision of Care - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - ANSWER- Observation, monitoring and tracking of results make up the
process of compliance evaluation required to document compliance.
Evaluation of technology - ANSWER- Ensuring that:
Insurance eligibility for current services
