Certified Revenue Cycle Representative (CRCR) Practice Exam

What is the purpose of a pre-admission review?

1. To determine patient eligibility for insurance

2. To review requests for inpatient admission for medical necessity

3. To schedule outpatient procedures

4. To verify patient information and insurance details

The correct answer is: To review requests for inpatient admission for medical necessity

A pre-admission review plays a crucial role in the revenue cycle management process, particularly in assessing whether a proposed inpatient admission is medically necessary. This process involves evaluating the specific clinical indicators and treatment guidelines to determine if the patient's condition justifies hospitalization. By conducting a pre-admission review, healthcare organizations can ensure that they comply with insurance requirements and that the treatment aligns with accepted standards of care. This helps to mitigate the risk of denied claims and ensures that patients receive appropriate care based on their medical needs. This function is vital for maintaining the financial health of healthcare providers and ensuring that patients receive the care necessary for their conditions. In contrast, other options serve different purposes. Assessing patient eligibility for insurance relates to eligibility verification processes, scheduling outpatient procedures focuses on planning care rather than determining medical necessity, and verifying patient information pertains to confirming administrative details rather than clinical necessity. Each of these plays an important role in the overall healthcare management workflow but does not encapsulate the primary aim of a pre-admission review.