CRCR EXAM [2026/2027 ]
UPDATED VERSION |
VERIFIED QUESTIONS
1. What do Case Managers do? - CORRECT ANSWER -Monitor high
resource cases to ensure effective utilization
2. What is HIM responsible for? - CORRECT ANSWER -all pt medical
records: transcribe, coding, release to biling, answer requests for
documentation
3. What is utilization management responsible for? - CORRECT ANSWER -
manage cases: services correct, on time
4. What are the three types of utilization review? - CORRECT ANSWER -
Prospective, Concurrent, Retrospective
,5. Where can home health services be offered? - CORRECT ANSWER -
Home, Assist Living, neighbors: just not SNF nor Hospital
6. To receive -Care payments, what must a SNF have when receiving a pt
from a hosp? - CORRECT ANSWER -A transfer agreement approved by -
Care.
7. Can a home health agency employ another agency to provide services? -
CORRECT ANSWER -Yes, so long as at least one employee of the original
agency provides care.
8. What is the Net Collection Rate? - CORRECT ANSWER -how much cash
was collected as a % of available to collect?
9. What is the Net Collection Rate benchmark? - CORRECT ANSWER -95%
10.What is the benchmark for denials - CORRECT ANSWER -<2% on first
submission
,11.Formual for cost to collect - CORRECT ANSWER -total PFS
expenses/gross pt care collections
12.What is the benchmark for cost to collect - CORRECT ANSWER -2.25%
13.What % of the UB-04 source of data is from pt access? - CORRECT
ANSWER -40%
14.What % of the UB-04 source of data is from service depts? - CORRECT
ANSWER -11%
15.What % of the UB-04 source of data is from HIM? - CORRECT ANSWER -
20%
16.What % of the UB-04 source of data is from billing? - CORRECT ANSWER
-20%
, 17.What % of the UB-04 source of data is not used? - CORRECT ANSWER -
9%
18.What % of the CMS 1500 source of data is from pt access? - CORRECT
ANSWER -53%
19.What % of the CMS 1500 source of data is from service? - CORRECT
ANSWER -14%
20.What % of the CMS 1500 source of data is from HIM - CORRECT ANSWER
-7%
21.What % of the CMS 1500 source of data is from billing? - CORRECT
ANSWER -26%
22.From whom is the UB-04 directed? - CORRECT ANSWER -institutional:
hospitals, SNF, hospice
UPDATED VERSION |
VERIFIED QUESTIONS
1. What do Case Managers do? - CORRECT ANSWER -Monitor high
resource cases to ensure effective utilization
2. What is HIM responsible for? - CORRECT ANSWER -all pt medical
records: transcribe, coding, release to biling, answer requests for
documentation
3. What is utilization management responsible for? - CORRECT ANSWER -
manage cases: services correct, on time
4. What are the three types of utilization review? - CORRECT ANSWER -
Prospective, Concurrent, Retrospective
,5. Where can home health services be offered? - CORRECT ANSWER -
Home, Assist Living, neighbors: just not SNF nor Hospital
6. To receive -Care payments, what must a SNF have when receiving a pt
from a hosp? - CORRECT ANSWER -A transfer agreement approved by -
Care.
7. Can a home health agency employ another agency to provide services? -
CORRECT ANSWER -Yes, so long as at least one employee of the original
agency provides care.
8. What is the Net Collection Rate? - CORRECT ANSWER -how much cash
was collected as a % of available to collect?
9. What is the Net Collection Rate benchmark? - CORRECT ANSWER -95%
10.What is the benchmark for denials - CORRECT ANSWER -<2% on first
submission
,11.Formual for cost to collect - CORRECT ANSWER -total PFS
expenses/gross pt care collections
12.What is the benchmark for cost to collect - CORRECT ANSWER -2.25%
13.What % of the UB-04 source of data is from pt access? - CORRECT
ANSWER -40%
14.What % of the UB-04 source of data is from service depts? - CORRECT
ANSWER -11%
15.What % of the UB-04 source of data is from HIM? - CORRECT ANSWER -
20%
16.What % of the UB-04 source of data is from billing? - CORRECT ANSWER
-20%
, 17.What % of the UB-04 source of data is not used? - CORRECT ANSWER -
9%
18.What % of the CMS 1500 source of data is from pt access? - CORRECT
ANSWER -53%
19.What % of the CMS 1500 source of data is from service? - CORRECT
ANSWER -14%
20.What % of the CMS 1500 source of data is from HIM - CORRECT ANSWER
-7%
21.What % of the CMS 1500 source of data is from billing? - CORRECT
ANSWER -26%
22.From whom is the UB-04 directed? - CORRECT ANSWER -institutional:
hospitals, SNF, hospice
