Certified Revenue Cycle Representative (CRCR) Practice Exam

What is the purpose of pre-admission review?

1. To verify the patient's insurance coverage

2. To review requests for inpatient admission before it occurs

3. To conduct post-discharge evaluations

4. To schedule outpatient procedures

The correct answer is: To review requests for inpatient admission before it occurs

The purpose of pre-admission review is fundamentally to assess requests for inpatient admissions prior to the actual admission taking place. This process is crucial in ensuring that all necessary criteria are met for an inpatient stay, including medical necessity and appropriateness of the planned treatment. It often involves evaluating the patient's clinical information to confirm that the admission is warranted and aligns with policy guidelines, which helps in managing the overall efficiency of hospital resources and reducing unnecessary admissions. This review is instrumental in the revenue cycle by ensuring that the health care organization can confirm the appropriateness of the service being rendered, which is essential for reimbursement from insurance providers. It also plays a vital role in optimizing patient care, as it ensures that patients receive the necessary level of care at the right time and location, thus preventing premature or unnecessary admissions. Other options, while related to the patient care process, do not specifically capture the essence of pre-admission review as accurately as this one does. Verifying insurance coverage pertains more to financial processes rather than the pre-screening of admission necessity. Post-discharge evaluations occur after the patient has been discharged and have no relation to the pre-admission phase. Scheduling outpatient procedures relates to a different aspect of the healthcare system, focusing on non-inpatient services.