CRCR – ST EXAM QUESTIONS AND ANSWERS
Dollars and Sense initiative (consistency, clarity, and transparency to patient financial communications) -
3 healthcare revenue cycle initiatives - CORRECT ANSWER✅✅- Patient financial communications best
practices
- Best practices for price transparency
- Medical account resolution
Patient Financial Communications - ED - CORRECT ANSWER✅✅if patient is having a medical
emergency, financial conversation should occur during discharge. If it isn't an emergency it can happen
at registration or discharge
Patient Financial Communications - Advance of service - CORRECT ANSWER✅✅financial discussions can
occur via outbound, inbound contact, there should be reasonable attempt to have the discussion as
early possible before financial obligation has occurred.
Patient Financial Communications - Time of service (not ED) - CORRECT ANSWER✅✅financial discussion
can happen at registration or discharge so as not to disrupt the patient flow
Patient Financial Communications - Routine and complex scenarios - CORRECT ANSWER✅✅patients
should be given the opportunity to request a patient advocate, family member, or other designee to
help
Patient Financial Communications - routine scenarios - CORRECT ANSWER✅✅Routine: patients with
insurance and ability to pay, discussions should take place between patient/guarantor and a properly
trained provider rep
Patient Financial Communications - complex scenarios - CORRECT ANSWER✅✅Complex: uninsured,
underinsured patients a financial counselor/supervisor should be involved
Patient Share: - CORRECT ANSWER✅✅- Patients should be told about the types of service providers
(pathologists, radiologist, anesthesiologist, etc) who typically participate in the service. Patients should
receive written list of service provider types upon request. Should be informed that actual costs may
vary from estimates, depending on the actual services performed or timing issues related to other
payments that may affect their deductible.
,- Patients should be asked if they are interested in receiving information about payment options or
financial assistance programs.
- Discussion should not interfere with patient care, and should focus on patient education
Financial Counseling - CORRECT ANSWER✅✅-Providers should have widely publicized toll-free number
for patients to call to receive assistance, and address concerns
-It is hard to focus on financial matters when urgent health matters happen at the same time. It is
important to make it convenient and the appropriate time.
-Provider should maintain a thread of pre-reg discussions and avoid repeated requests for the same
information
Prior Balances - CORRECT ANSWER✅✅- Providers should have clear policies on prior balance policies
that are available to the public. Providers should have technology that give financial reps current info
about patient financial obligations.
Balance Resolution - CORRECT ANSWER✅✅- Discussion should focus on amicable resolution. Balance
resolution discussion may occur concerning prior balances that are currently being pursued for
collection by the provider, a collection agency, etc
- Provider rep may discuss services that led to the prior balance, should provider write list of services,
dates of services. Should ask patient if they want to receive information about payment
options/financial assistance. They may also proactively attempt to resolve prior balance through
insurance/financial assistance programs.
- Once these steps have been completed, it is appropriate to ask the patient how they would like to
resolve the balance and inform them of any collection activity
The Provider - Patient Conversation - CORRECT ANSWER✅✅Compassion, Communication, Written
Follow-up
Compliance Framework - CORRECT ANSWER✅✅- Executive level metrics reporting - presented to
executive leadership annually
- Training Program - completed annually, and should cover best practices, financial assistance policies,
financing options, alternative options for the for the uninsured, standard language to be used, laws and
regulations (EMTALA, fair debt collections, TCPA, etc)
, - Process Compliance - annual observation, monitoring, tracking of results, should be comprehensive
and include all scenarios.
- Technology - should include eligibility verification, verification of existing prior balance, estimated costs
(PRE)
- Feedback process and response - solicit and receive input from stakeholders, ensure patient
complaints are resolved.
Charge Master - CORRECT ANSWER✅✅lists total charge, not net charges that reflect payers contractual
adjustment
Price Transparency - CORRECT ANSWER✅✅Readily available information on the price of healthcare
services, that, together with other information, helps define the value of those services and enables
patients and other care purchasers to identify, compare, and choose providers that offer the desired
level of value.
Medical Account Resolution (Medical debt task force) - CORRECT ANSWER✅✅- Educate - educate
patients, and follow best practices
- Bills - clear, concise, correct and patient friendly
- Policies - establish policies, and make sure they are followed
- Consistency - from billing disputes to payment application
- Coordinate - avoid duplicate patient contacts
- Judgement - use good judgement and the best ways to communicate with patients about bills
- Timing - set the account resolution clock when the first statement is sent to the patient
- Report and Track - report to credit bureaus when an account is resolved, track all consumer complaints
OIG - CORRECT ANSWER✅✅Office of Inspector General developed the Model Compliance Plan for
Clinical Laboratories in 1997, and the Compliance Program Guidance for Hospitals in 1998. These
guidance documents all have the U.S. Sentencing Commission Guidelines as their core.
Compliance & HIPAA Requirements Risk Areas - CORRECT ANSWER✅✅- "Upcoding" of MS-DRG
assignments
- Inaccurate or incorrect coding
Dollars and Sense initiative (consistency, clarity, and transparency to patient financial communications) -
3 healthcare revenue cycle initiatives - CORRECT ANSWER✅✅- Patient financial communications best
practices
- Best practices for price transparency
- Medical account resolution
Patient Financial Communications - ED - CORRECT ANSWER✅✅if patient is having a medical
emergency, financial conversation should occur during discharge. If it isn't an emergency it can happen
at registration or discharge
Patient Financial Communications - Advance of service - CORRECT ANSWER✅✅financial discussions can
occur via outbound, inbound contact, there should be reasonable attempt to have the discussion as
early possible before financial obligation has occurred.
Patient Financial Communications - Time of service (not ED) - CORRECT ANSWER✅✅financial discussion
can happen at registration or discharge so as not to disrupt the patient flow
Patient Financial Communications - Routine and complex scenarios - CORRECT ANSWER✅✅patients
should be given the opportunity to request a patient advocate, family member, or other designee to
help
Patient Financial Communications - routine scenarios - CORRECT ANSWER✅✅Routine: patients with
insurance and ability to pay, discussions should take place between patient/guarantor and a properly
trained provider rep
Patient Financial Communications - complex scenarios - CORRECT ANSWER✅✅Complex: uninsured,
underinsured patients a financial counselor/supervisor should be involved
Patient Share: - CORRECT ANSWER✅✅- Patients should be told about the types of service providers
(pathologists, radiologist, anesthesiologist, etc) who typically participate in the service. Patients should
receive written list of service provider types upon request. Should be informed that actual costs may
vary from estimates, depending on the actual services performed or timing issues related to other
payments that may affect their deductible.
,- Patients should be asked if they are interested in receiving information about payment options or
financial assistance programs.
- Discussion should not interfere with patient care, and should focus on patient education
Financial Counseling - CORRECT ANSWER✅✅-Providers should have widely publicized toll-free number
for patients to call to receive assistance, and address concerns
-It is hard to focus on financial matters when urgent health matters happen at the same time. It is
important to make it convenient and the appropriate time.
-Provider should maintain a thread of pre-reg discussions and avoid repeated requests for the same
information
Prior Balances - CORRECT ANSWER✅✅- Providers should have clear policies on prior balance policies
that are available to the public. Providers should have technology that give financial reps current info
about patient financial obligations.
Balance Resolution - CORRECT ANSWER✅✅- Discussion should focus on amicable resolution. Balance
resolution discussion may occur concerning prior balances that are currently being pursued for
collection by the provider, a collection agency, etc
- Provider rep may discuss services that led to the prior balance, should provider write list of services,
dates of services. Should ask patient if they want to receive information about payment
options/financial assistance. They may also proactively attempt to resolve prior balance through
insurance/financial assistance programs.
- Once these steps have been completed, it is appropriate to ask the patient how they would like to
resolve the balance and inform them of any collection activity
The Provider - Patient Conversation - CORRECT ANSWER✅✅Compassion, Communication, Written
Follow-up
Compliance Framework - CORRECT ANSWER✅✅- Executive level metrics reporting - presented to
executive leadership annually
- Training Program - completed annually, and should cover best practices, financial assistance policies,
financing options, alternative options for the for the uninsured, standard language to be used, laws and
regulations (EMTALA, fair debt collections, TCPA, etc)
, - Process Compliance - annual observation, monitoring, tracking of results, should be comprehensive
and include all scenarios.
- Technology - should include eligibility verification, verification of existing prior balance, estimated costs
(PRE)
- Feedback process and response - solicit and receive input from stakeholders, ensure patient
complaints are resolved.
Charge Master - CORRECT ANSWER✅✅lists total charge, not net charges that reflect payers contractual
adjustment
Price Transparency - CORRECT ANSWER✅✅Readily available information on the price of healthcare
services, that, together with other information, helps define the value of those services and enables
patients and other care purchasers to identify, compare, and choose providers that offer the desired
level of value.
Medical Account Resolution (Medical debt task force) - CORRECT ANSWER✅✅- Educate - educate
patients, and follow best practices
- Bills - clear, concise, correct and patient friendly
- Policies - establish policies, and make sure they are followed
- Consistency - from billing disputes to payment application
- Coordinate - avoid duplicate patient contacts
- Judgement - use good judgement and the best ways to communicate with patients about bills
- Timing - set the account resolution clock when the first statement is sent to the patient
- Report and Track - report to credit bureaus when an account is resolved, track all consumer complaints
OIG - CORRECT ANSWER✅✅Office of Inspector General developed the Model Compliance Plan for
Clinical Laboratories in 1997, and the Compliance Program Guidance for Hospitals in 1998. These
guidance documents all have the U.S. Sentencing Commission Guidelines as their core.
Compliance & HIPAA Requirements Risk Areas - CORRECT ANSWER✅✅- "Upcoding" of MS-DRG
assignments
- Inaccurate or incorrect coding
