CRCR Exam; Questions with Complete
Solutions (Latest Update)
What do Case Managers do? ✔✔ Monitor high resource cases to ensure
effective
utilization
What is HIM responsible for? ✔✔ all pt medical records: transcribe, coding,
release to
biling, answer requests for documentation
What is utilization management responsible for? ✔✔ manage cases: services
correct,
on time
What are the three types of utilization review? ✔✔ Prospective, Concurrent,
Retrospective
Where can home health services be offered? ✔✔ Home, Assist Living, neighbors:
just
not SNF nor Hospital
, CRCR Exam; Questions with Complete
Solutions (Latest Update)
To receive -Care payments, what must a SNF have when receiving a pt from a
hosp?
✔✔ A transfer agreement approved by -Care.
Can a home health agency employ another agency to provide services? ✔✔ Yes,
so
long as at least one employee of the original agency provides care.
What is the Net Collection Rate? ✔✔ how much cash was collected as a % of
available
to collect?
What is the Net Collection Rate benchmark? ✔✔ 95%
What is the benchmark for denials ✔✔ <2% on first submission
Formual for cost to collect ✔✔ total PFS expenses/gross pt care collections
What is the benchmark for cost to collect ✔✔ 2.25%
What % of the UB-04 source of data is from pt access? ✔✔ 40%
, CRCR Exam; Questions with Complete
Solutions (Latest Update)
What % of the UB-04 source of data is from service depts? ✔✔ 11%
What % of the UB-04 source of data is from HIM? ✔✔ 20%
What % of the UB-04 source of data is from billing? ✔✔ 20%
What % of the UB-04 source of data is not used? ✔✔ 9%
What % of the CMS 1500 source of data is from pt access? ✔✔ 53%
What % of the CMS 1500 source of data is from service? ✔✔ 14%
What % of the CMS 1500 source of data is from HIM ✔✔ 7%
What % of the CMS 1500 source of data is from billing? ✔✔ 26%
From whom is the UB-04 directed? ✔✔ institutional: hospitals, SNF, hospice
From whom is the CMS 1500? ✔✔ non-institutional: physicians, DME
In the FDCA, what is Title I ✔✔ Truth in Lending Act
What is the Truth in Lending Act ✔✔ 5 points must be triggered (such as interest
will be
charged), then must disclose APR, total payments, late payment charges, etc.
Solutions (Latest Update)
What do Case Managers do? ✔✔ Monitor high resource cases to ensure
effective
utilization
What is HIM responsible for? ✔✔ all pt medical records: transcribe, coding,
release to
biling, answer requests for documentation
What is utilization management responsible for? ✔✔ manage cases: services
correct,
on time
What are the three types of utilization review? ✔✔ Prospective, Concurrent,
Retrospective
Where can home health services be offered? ✔✔ Home, Assist Living, neighbors:
just
not SNF nor Hospital
, CRCR Exam; Questions with Complete
Solutions (Latest Update)
To receive -Care payments, what must a SNF have when receiving a pt from a
hosp?
✔✔ A transfer agreement approved by -Care.
Can a home health agency employ another agency to provide services? ✔✔ Yes,
so
long as at least one employee of the original agency provides care.
What is the Net Collection Rate? ✔✔ how much cash was collected as a % of
available
to collect?
What is the Net Collection Rate benchmark? ✔✔ 95%
What is the benchmark for denials ✔✔ <2% on first submission
Formual for cost to collect ✔✔ total PFS expenses/gross pt care collections
What is the benchmark for cost to collect ✔✔ 2.25%
What % of the UB-04 source of data is from pt access? ✔✔ 40%
, CRCR Exam; Questions with Complete
Solutions (Latest Update)
What % of the UB-04 source of data is from service depts? ✔✔ 11%
What % of the UB-04 source of data is from HIM? ✔✔ 20%
What % of the UB-04 source of data is from billing? ✔✔ 20%
What % of the UB-04 source of data is not used? ✔✔ 9%
What % of the CMS 1500 source of data is from pt access? ✔✔ 53%
What % of the CMS 1500 source of data is from service? ✔✔ 14%
What % of the CMS 1500 source of data is from HIM ✔✔ 7%
What % of the CMS 1500 source of data is from billing? ✔✔ 26%
From whom is the UB-04 directed? ✔✔ institutional: hospitals, SNF, hospice
From whom is the CMS 1500? ✔✔ non-institutional: physicians, DME
In the FDCA, what is Title I ✔✔ Truth in Lending Act
What is the Truth in Lending Act ✔✔ 5 points must be triggered (such as interest
will be
charged), then must disclose APR, total payments, late payment charges, etc.
