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 1 / 3
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%
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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
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