CRCR Exam Prep Ques ons and answers Updated RATED
A+ NEW!!
What do Case Managers do? - Ans Monitor high resource cases to ensure effec ve u liza on
What is HIM responsible for? - Ans all pt medical records: transcribe, coding, release to biling,
answer requests for documenta on
What is u liza on management responsible for? - Ans manage cases: services correct, on me
What are the three types of u liza on review? - Ans Prospec ve, Concurrent, Retrospec ve
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 Collec on Rate? - Ans how much cash was collected as a % of available to
collect?
What is the Net Collec on Rate benchmark? - Ans 95%
What is the benchmark for denials - Ans <2% on first submission
,Formual for cost to collect - Ans total PFS expenses/gross pt care collec ons
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 ins tu onal: hospitals, SNF, hospice
From whom is the CMS 1500? - Ans non-ins tu onal: 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 penal es for viola ng 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 Repor ng Act
What is the Fair Credit Repor ng Act? - Ans provides consumer rights in repor ng 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 are the three types of pt access incoming to a HCO? - Ans scheduled, unscheduled,
recurring
What is LCD - Ans local coverage determinants, in absence of NCD, LCD dtermines whether -
Care will pay for an item or service
A+ NEW!!
What do Case Managers do? - Ans Monitor high resource cases to ensure effec ve u liza on
What is HIM responsible for? - Ans all pt medical records: transcribe, coding, release to biling,
answer requests for documenta on
What is u liza on management responsible for? - Ans manage cases: services correct, on me
What are the three types of u liza on review? - Ans Prospec ve, Concurrent, Retrospec ve
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 Collec on Rate? - Ans how much cash was collected as a % of available to
collect?
What is the Net Collec on Rate benchmark? - Ans 95%
What is the benchmark for denials - Ans <2% on first submission
,Formual for cost to collect - Ans total PFS expenses/gross pt care collec ons
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 ins tu onal: hospitals, SNF, hospice
From whom is the CMS 1500? - Ans non-ins tu onal: 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 penal es for viola ng 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 Repor ng Act
What is the Fair Credit Repor ng Act? - Ans provides consumer rights in repor ng 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 are the three types of pt access incoming to a HCO? - Ans scheduled, unscheduled,
recurring
What is LCD - Ans local coverage determinants, in absence of NCD, LCD dtermines whether -
Care will pay for an item or service
