Patient Access and Registration
Why the front door decides the claim
Patient Access sets the data that every downstream system consumes. A registration error is not a clerical problem; it becomes a denial, a re-work cost, and a delayed cash posting. Candidates must understand the core registration data set: legal name as it appears on the insurance card, date of birth, member ID, group number, payer and plan type, subscriber-versus-patient relationship, and coordination of benefits (COB) order.
Concepts to master
- Eligibility verification (270/271) at or before the visit, including effective dates and covered benefits.
- COB: primary/secondary determination, birthday rule for dependent children, Medicare Secondary Payer rules for working aged and ESRD.
- Referral and authorization capture at scheduling, not at check-in.
- Point-of-service collections and financial clearance.
- Identity verification and medical record number integrity to prevent duplicate records.
Traps in questions
Questions often present a patient who "has insurance" but whose coverage terminated before the date of service, or a Medicare beneficiary with active employer coverage. Another classic trap is confusing the subscriber with the patient when the patient is a dependent. Also watch for questions implying that eligibility verification guarantees payment; it does not verify benefits remaining or medical necessity.
Rule of thumb
Verify, document, and re-verify at every encounter. If a question offers "check eligibility at the time of service" versus "check eligibility at scheduling," the earlier, more thorough answer is usually correct.
Worked example
A 68-year-old Medicare patient still working full time for an employer with 25 employees presents for a visit. Medicare is secondary because the employer group health plan is primary under working-aged MSP rules. Registering Medicare as primary would produce a denial and a COB correction later.