Certified Revenue Cycle Representative (CRCR) Practice Exam

What does the term gatekeeping imply in healthcare?

1. The management of healthcare costs by limiting provider choice

2. Organizing healthcare services through primary care physicians

3. Allowing patients to see specialists without referral

4. Ensuring hospitals are the primary point of care

The correct answer is: Organizing healthcare services through primary care physicians

The term gatekeeping in healthcare primarily refers to the role that primary care physicians play in managing patient access to various healthcare services. By organizing healthcare services this way, primary care providers serve as the first point of contact for patients, guiding them through the healthcare system and determining the necessity for specialist referrals or additional services. This model aims to ensure that patients receive appropriate and efficient care while helping to control healthcare costs and avoid unnecessary treatments. This approach contrasts with direct access models, where patients can directly visit specialists without referral, which could lead to fragmented care. While there are elements of cost management and provider choice involved in the broader context of healthcare, the defining characteristic of gatekeeping is the organizing role of primary care in patient pathways.