CRCR Exam : Questions & Answers
What do Case Managers do?
(Ans- Monitor high resource cases to ensure effective utilization
What is HIM responsible for?
(Ans- all pt medical records: transcribe, coding, release to biling, answer
requests for documentation
What is utilization management responsible for?
(Ans- manage cases: services correct, on time
What are the three types of utilization review?
(Ans- Prospective, Concurrent, Retrospective
Where can home health services be offered?
(Ans- 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?
(Ans- A transfer agreement approved by -Care.
Can a home health agency employ another agency to provide services?
(Ans- Yes, so long as at least one employee of the original agency provides
care.
What is the Net Collection Rate?
(Ans- how much cash was collected as a % of available to collect?
What is the Net Collection Rate benchmark?
(Ans- 95%
What is the benchmark for denials
(Ans- <2% on first submission
,Formula for cost to collect
(Ans- total PFS expenses/gross pt care collections
What is the benchmark for cost to collect
(Ans- 2.25%
What % of the UB-04 source of data is from pt access?
(Ans- 40%
What % of the UB-04 source of data is from service depts?
(Ans- 11%
What % of the UB-04 source of data is from HIM?
(Ans- 20%
What % of the UB-04 source of data is from billing?
(Ans- 20%
What % of the UB-04 source of data is not used?
(Ans- 9%
What % of the CMS 1500 source of data is from pt access?
(Ans- 53%
What % of the CMS 1500 source of data is from service?
(Ans- 14%
What % of the CMS 1500 source of data is from HIM
(Ans- 7%
What % of the CMS 1500 source of data is from billing?
(Ans- 26%
, From whom is the UB-04 directed?
(Ans- institutional: hospitals, SNF, hospice
From whom is the CMS 1500?
(Ans- non-institutional: physicians, DME
In the FDCA, what is Title I
(Ans- Truth in Lending Act
What is the Truth in Lending Act
(Ans- 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?
(Ans- creditors can be sued
Who enforces the FDCA for hospitals?
(Ans- FTC
In the FDCA, what is Title III
(Ans- limits garnishments
In the FDCA, what is Title IV
(Ans- Fair Credit Reporting Act
What is the Fair Credit Reporting Act?
(Ans- provides consumer rights in reporting loans
Are there rules for how a debt collector communicates with debtor?
(Ans- Yes, eg no profane language, can't contact before 8 AM
Is a newborn a scheduled or unscheduled pt
(Ans- unscheduled
What do Case Managers do?
(Ans- Monitor high resource cases to ensure effective utilization
What is HIM responsible for?
(Ans- all pt medical records: transcribe, coding, release to biling, answer
requests for documentation
What is utilization management responsible for?
(Ans- manage cases: services correct, on time
What are the three types of utilization review?
(Ans- Prospective, Concurrent, Retrospective
Where can home health services be offered?
(Ans- 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?
(Ans- A transfer agreement approved by -Care.
Can a home health agency employ another agency to provide services?
(Ans- Yes, so long as at least one employee of the original agency provides
care.
What is the Net Collection Rate?
(Ans- how much cash was collected as a % of available to collect?
What is the Net Collection Rate benchmark?
(Ans- 95%
What is the benchmark for denials
(Ans- <2% on first submission
,Formula for cost to collect
(Ans- total PFS expenses/gross pt care collections
What is the benchmark for cost to collect
(Ans- 2.25%
What % of the UB-04 source of data is from pt access?
(Ans- 40%
What % of the UB-04 source of data is from service depts?
(Ans- 11%
What % of the UB-04 source of data is from HIM?
(Ans- 20%
What % of the UB-04 source of data is from billing?
(Ans- 20%
What % of the UB-04 source of data is not used?
(Ans- 9%
What % of the CMS 1500 source of data is from pt access?
(Ans- 53%
What % of the CMS 1500 source of data is from service?
(Ans- 14%
What % of the CMS 1500 source of data is from HIM
(Ans- 7%
What % of the CMS 1500 source of data is from billing?
(Ans- 26%
, From whom is the UB-04 directed?
(Ans- institutional: hospitals, SNF, hospice
From whom is the CMS 1500?
(Ans- non-institutional: physicians, DME
In the FDCA, what is Title I
(Ans- Truth in Lending Act
What is the Truth in Lending Act
(Ans- 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?
(Ans- creditors can be sued
Who enforces the FDCA for hospitals?
(Ans- FTC
In the FDCA, what is Title III
(Ans- limits garnishments
In the FDCA, what is Title IV
(Ans- Fair Credit Reporting Act
What is the Fair Credit Reporting Act?
(Ans- provides consumer rights in reporting loans
Are there rules for how a debt collector communicates with debtor?
(Ans- Yes, eg no profane language, can't contact before 8 AM
Is a newborn a scheduled or unscheduled pt
(Ans- unscheduled
