CRCR
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 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
