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CERTIFIED REVENUE CYCLE REPRESENTATIVE - CRCR QUESTIONS AND CORRECT ANSWERS
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CERTIFIED REVENUE CYCLE REPRESENTATIVE - CRCR QUESTIONS AND CORRECT ANSWERS
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Page 1 of 19 SUCCESS! 1 CERTIFIED REVENUE CYCLE REPRESENTATIVE - CRCR QUESTIONS AND CORRECT ANSWERS 2024 -2025 Patient -Centric Revenue Cycle - ANSWER✔✔The major processing steps required for a request for service through closing the account at zero balance. Pre-Service - ANSWER✔✔Scheduled & pre -registered pt.,cost est., data colleted Time -Of-Service - ANSWER✔✔Scheduled & Unscheduled -caser mgmt. & discharge, consents, pt is id'd, copay & amt collected, pre reg record activated.Unsched pt have comprehensive regis & financial processing Post -Service - ANSWER✔✔After pt is discharged -bill to healthplan, pt account monitored until payment reaches zero Healthcare Dollars and Sense - ANSWER✔✔Name given to the 3 HFMA revenue cycle initiatives: Patient Financial Communications Price Transparency Medical Account Resolution Page 2 of 19 SUCCESS! 2 Patient financial communications best practices purpose & principles - ANSWER✔✔· All patient financial interactions · Emergency department · Advance of service · Time of service (outside the emergency department) · Measurement criteria framework Best Practices for price transparency - ANSWER✔✔As part pf the consumer driven programs, patients need pricing information to make informed healthcare choices in hospitals to inquire about costs and fees prior to agreeing to service. A. Required information for pricing include: type of hospital service (based on CPT/HCPCS or MS-DRG code), patients' health plan and/or benefit plan Medical account resolution - ANSWER✔✔Educate, bills, policies, consistency, coordinate, judgement, timing, report and track Financial Counseling - ANSWER✔✔If appropriate, patient is referred to for financial assistance. Typically patient share, prior balances, balance resolution Typical elements of financial discussions - ANSWER✔✔Including provision of care, registration, insurance verification, and financial counseling (patient share, prior balances, balance resolution) Page 3 of 19 SUCCESS! 3 Provision of care - ANSWER✔✔The patient to make mutually acceptable payment arrangements to resolve outstanding balance. Ability to pay will not interfere with treatment . Balance resolution - ANSWER✔✔Discussions may occur concerning prior balances that are being handled by collection by provider, a collection of agency, or other organization Price transparency - ANSWER✔✔On Health Insurance Marketplace / Health Insurance Exchange have consumer cost sharing requirement. Patients expect clarity & communication of costs, helps consumers make smarter decisions about care received. The need for Pricing Transparency - ANSWER✔✔Patients need pricing information, key info needed are type of hospital service on CPT or MS -DRG code, patients health and benefit plans Medical Account Resolution - ANSWER✔✔HFMA partnered with ACA (Association of Credit & Collections) along with others to work on medical debt task force. What are the Medical Account Resolution Best Practices - ANSWER✔✔Educate, bills, policies, consistency, coordinate, judgement, timing, and report & track. (See diagram) What option is NOT a main HFMA Healthcare Dollars and Sense revenue cycle initiative?The benefits of buying summaries with Stuvia:
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