CRCR HFMA Certified Revenue Cycle Rep Exam: Understanding Healthcare Dollars & Sense, Exams of Finance

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CRCR HFMA Certified Revenue Cycle Representative Exam

(2023 – 2024) With Complete Solutions

L earning Objective 1/2: Discuss the components of the 3 HFMA revenue cycle initiatives collectively called Healthcare Dollars & Sense. - n/a

Learning Objective 2/2: Summarize the best practices for each of the 3 Healthcare Dollars & Sense Initiatives. - n/a

Healthcare Dollars & Sense is the name given to what 3 HFMA revenue cycle initiatives? - - Patient financial communications best practices

• Best practices for price transparency
• Medical account resolution

What question does Healthcare Dollars & Sense answer for patients and consumers? - to help make sense of price and value in healthcare.

What are the 3 components/best practices of Healthcare Dollars & Sense - Price Transparency, Patient Financial Communications, and Medical Account Resolution.

What is the Emergency Medical Treatment and Active Labor Act (EMTALA)? - requires ER departments to provide a medical screening examination to any individual who comes into the ER department and requests an examination/treatment; prohibits ER departments from refusing to examine or treat individuals with an emergency condition.

In an ED, when should you engage in financial discussions with patients? - During the discharge process

In an ED, if a patient does not have a medical condition, when should you discuss the financial discussion? - After the medical screening, and either during the registration or discharge process.

If an ED patient does not have an emergency medical condition, can you then engage in financial discussions? - No, you must ensure the medical screening is complete first.

Outside the ED setting, when can you have financial discussions with patients? - Either during the registration or discharge process - as long as the patient flow is not disrupted.

According to best practices, when should you make a reasonable attempt to have a financial discussion with a patient? - Before a financial obligation is incurred (before care is provided).

Why does best practices support financial discussions before care is provided? - To ensure that patients are aware of their financial obligations and that providers are aware of the patient's ability to pay or the source of payment.

Routine & Complex Scenarios: the best practices specifies that patients should be given the opportunities to request what to help them with financial discussions? - a patient advocate, family member, or other designee to help them in the discussions.

For Routine Scenarios: for patients with insurance coverage or a know ability to pay, who should be involved in the financial discussions? - the patient or guarantor and properly trained provider representatives.

For Complex Scenarios: for patients with non-routine or complex scenarios, such as uninsured or underinsured patients, who should be involved in the financial discussions? - the patient and financial counselor or supervisor.

Routine Activities: Provision of Care: who should be informed that their ability to pay will not interfere with treatment or any emergency medical condition? The insured / able to pay or the uninsured? - all patients should be informed.

Routine Activities: Provision of Care: when having a financial discussion with uninsured ED patients, you should explain the goal of collecting information to identify payment solutions. What

is goal? - To find payment solutions or financial assistance options that may help them with their financial obligations for the ED visit.

Routine Activities: Provision of Care: in modern time, why is it so important to ensure patients are informed of their different coverage options? - because there are new options for coverage, as the Affordable Care Act, marketplace insurance, and the expansion of Medicaid offer more options.

Also, providers should:

A. have both elective and non-elective procedures clearly defined for the public

B. only elective procedures clearly defined, and non-elective are mandatory

C. only non-elective, as they are mandatory. - A.

When should the provider representative review insurance eligibility information with the patient?

• During the process of engaging in a financial discussion.

You should give patients the opportunity to have financial counseling. What is this? - The opportunity to request a patient advocare, family member, or other designee to help the patients make financial decisions.

Patient Share:HFMA's patient financial communications best practices specify that patient should be told about the types of service providers who typically participate in a service. How can you inform patients about the types of providers offered, and how you discussion the costs of the various services? - Upon request, I must provide a list of service provider types. I must also inform the patient 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. I should ask patients if they are interested in receiving information about payment options and/or the provider's financial assistance options.

Prior Balances: How should practices inform patients of prior balances? - Practices must have clear policies about prior balances, and they should make those policies public.

Balance Resolution: how should you discuss prior balances for resolution? - I may discuss prior balances that are currently being pursued for collection by the provider, a collection agency, or other organizations. I may also write a list of the prior services delivered, dates of service, and the resulting prior balance.

When having a financial discussion, you must preserve two values to comply with best practices to help give patients peace of mind and help providers receive appropriate payment. What are these two values? - Compassion and Communication

What are the 5 distinct areas of the Compliance Framework? - Training program, Process observation, Executive level metrics reporting, technology, and feedback process and response

Compliance Framework 1/5: What's Process Observation? - Annual observation, monitoring, and tracking of results make up the process of compliance evaluation required to document compliance with the best practices. The evaluation should be comprehensive and should cover all scenarios addressed by the practices that are relevant to a particular organization.

Compliance Framework 1/5: What's the Training Program? - HFMA's best practices call for annual training on the organization's financial assistance policies for all staff who engage in patient financial discussions, including patient access, financial counseling, and customer service representatives.

Compliance Framework: Training Program: What are the topics that must be covered? - - patient financial communications best practices specific to staff role

-Financial Assistance Policies

-Available patient financing options

-Alternative solutions for the uninsured

-laws/regulations, such as EMTALA, the Fair Debt Collections Practice Act, and the Telephone Consumer Protection Act - specific to the staff role.

Compliance Framework 1/5: What is the Executive Level Metrics Reporting? - Reports of organizational performance evaluations should be developed, compiled into an overall compliance report and presented to the organization's executive leadership team on an annual basis.

Compliance Framework 1/5: What is the Technology segment? - The compliance framework ensures that technology is in place to support verification of insurance eligibility for current services, verification of existing prior balance for current services, and estimated cost of the current services and the patient responsibility portion.

Compliance Framework 1/5: What is the Feedback and Response? - This evaluation is designed to ensure that processes are in place to regularly solicit input and receive key stakeholders'' feedback, measure and respond to input and feedback, and ensure that patient complaints are resolved.