(solved) CRCR Exam Questions and Answers Latest Update 2023.

(solved) CRCR Exam Questions and Answers Latest Update 2023 What do Case Managers do? - ANSWER-Monitor high resource cases to ensure effective utilization What is HIM responsible for? - ANSWER-all pt medical records: transcribe, coding, release to biling, answer requests for documentation What is utilization management responsible for? - ANSWER-manage cases: services correct, on time What are the three types of utilization review? - ANSWER-Prospective, Concurrent, Retrospective Where can home health services be offered? - ANSWER-Home, Assist Living, neighbors: just not SNF nor Hospital To receive -Care payments, what must a SNF have when receiving a pt from a hosp? - ANSWER-A transfer agreement approved by -Care. Can a home health agency employ another agency to provide services? - ANSWER-Yes, so long as at least one employee of the original agency provides care. What is the Net Collection Rate? - ANSWER-how much cash was collected as a % of available to collect? What is the Net Collection Rate benchmark? - ANSWER-95% What is the benchmark for denials - ANSWER-2% on first submission Formual for cost to collect - ANSWER-total PFS expenses/gross pt care collections What is the benchmark for cost to collect - ANSWER-2.25% What % of the UB-04 source of data is from pt access? - ANSWER-40% What % of the UB-04 source of data is from service depts? - ANSWER-11% What % of the UB-04 source of data is from HIM? - ANSWER-20% What % of the UB-04 source of data is from billing? - ANSWER-20% What % of the UB-04 source of data is not used? - ANSWER-9% What % of the CMS 1500 source of data is from pt access? - ANSWER-53% What % of the CMS 1500 source of data is from service? - ANSWER-14% What % of the CMS 1500 source of data is from HIM - ANSWER-7% What % of the CMS 1500 source of data is from billing? - ANSWER-26% From whom is the UB-04 directed? - ANSWER-institutional: hospitals, SNF, hospice From whom is the CMS 1500? - ANSWER-non-institutional: physicians, DME In the FDCA, what is Title I - ANSWER-Truth in Lending Act What is the Truth in Lending Act - ANSWER-5 points must be triggered (such as interest will be charged), then must disclose APR, total payments, late payment charges, etc. What are the penalties for violating the FDCA? - ANSWER-creditors can be sued Who enforces the FDCA for hospitals? - ANSWER-FTC In the FDCA, what is Title III - ANSWER-limits garnishments In the FDCA, what is Title IV - ANSWER-Fair Credit Reporting Act What is the Fair Credit Reporting Act? - ANSWER-provides consumer rights in reporting loans Are there rules for how a debt collector communicates with debtor? - ANSWER-Yes, eg no profane language, can't contact before 8 AM Is a newborn a scheduled or unscheduled pt - ANSWER-unscheduled What are the three types of pt access incoming to a HCO? - ANSWER-scheduled, unscheduled, recurring What is LCD - ANSWER-local coverage determinants, in absence of NCD, LCD dtermines whether -Care will pay for an item or service What is NCD - ANSWER-national coverage determinants:' nationwide determination of whether Medicare will pay for an item or service What % of pts should be pre-registered of all scheduled pts? - ANSWER-98% What is the code for HIPAA transaction set for HC eligibility and benefit responses - ANSWER-270 outgoing 271 response What are some payer data elements needed to process payment? - ANSWER-policy type, covered persons, mail address, cvr type (HMO), deductible