CRCR
What do Case Managers do? - ANSMonitor high resource cases to ensure effective utilization
What is HIM responsible for? - ANSall pt medical records: transcribe, coding, release to biling,
answer requests for documentation
What is utilization management responsible for? - ANSmanage cases: services correct, on time
What are the three types of utilization review? - ANSProspective, Concurrent, Retrospective
Where can home health services be offered? - ANSHome, Assist Living, neighbors: just not
SNF nor Hospital
To receive -Care payments, what must a SNF have when receiving a pt from a hosp? - ANSA
transfer agreement approved by -Care.
Can a home health agency employ another agency to provide services? - ANSYes, so long as
at least one employee of the original agency provides care.
What is the Net Collection Rate? - ANShow much cash was collected as a % of available to
collect?
What is the Net Collection Rate benchmark? - ANS95%
What is the benchmark for denials - ANS<2% on first submission
Formual for cost to collect - ANStotal PFS expenses/gross pt care collections
What is the benchmark for cost to collect - ANS2.25%
What % of the UB-04 source of data is from pt access? - ANS40%
What % of the UB-04 source of data is from service depts? - ANS11%
What % of the UB-04 source of data is from HIM? - ANS20%
What % of the UB-04 source of data is from billing? - ANS20%
What % of the UB-04 source of data is not used? - ANS9%
What % of the CMS 1500 source of data is from pt access? - ANS53%
, What % of the CMS 1500 source of data is from service? - ANS14%
What % of the CMS 1500 source of data is from HIM - ANS7%
What % of the CMS 1500 source of data is from billing? - ANS26%
From whom is the UB-04 directed? - ANSinstitutional: hospitals, SNF, hospice
From whom is the CMS 1500? - ANSnon-institutional: physicians, DME
In the FDCA, what is Title I - ANSTruth in Lending Act
What is the Truth in Lending Act - ANS5 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? - ANScreditors can be sued
Who enforces the FDCA for hospitals? - ANSFTC
In the FDCA, what is Title III - ANSlimits garnishments
In the FDCA, what is Title IV - ANSFair Credit Reporting Act
What is the Fair Credit Reporting Act? - ANSprovides consumer rights in reporting loans
Are there rules for how a debt collector communicates with debtor? - ANSYes, eg no profane
language, can't contact before 8 AM
Is a newborn a scheduled or unscheduled pt - ANSunscheduled
What are the three types of pt access incoming to a HCO? - ANSscheduled, unscheduled,
recurring
What is LCD - ANSlocal coverage determinants, in absence of NCD, LCD dtermines whether
-Care will pay for an item or service
What is NCD - ANSnational coverage determinants:' nationwide determination of whether
Medicare will pay for an item or service
What % of pts should be pre-registered of all scheduled pts? - ANS98%
What is the code for HIPAA transaction set for HC eligibility and benefit responses - ANS270
outgoing
What do Case Managers do? - ANSMonitor high resource cases to ensure effective utilization
What is HIM responsible for? - ANSall pt medical records: transcribe, coding, release to biling,
answer requests for documentation
What is utilization management responsible for? - ANSmanage cases: services correct, on time
What are the three types of utilization review? - ANSProspective, Concurrent, Retrospective
Where can home health services be offered? - ANSHome, Assist Living, neighbors: just not
SNF nor Hospital
To receive -Care payments, what must a SNF have when receiving a pt from a hosp? - ANSA
transfer agreement approved by -Care.
Can a home health agency employ another agency to provide services? - ANSYes, so long as
at least one employee of the original agency provides care.
What is the Net Collection Rate? - ANShow much cash was collected as a % of available to
collect?
What is the Net Collection Rate benchmark? - ANS95%
What is the benchmark for denials - ANS<2% on first submission
Formual for cost to collect - ANStotal PFS expenses/gross pt care collections
What is the benchmark for cost to collect - ANS2.25%
What % of the UB-04 source of data is from pt access? - ANS40%
What % of the UB-04 source of data is from service depts? - ANS11%
What % of the UB-04 source of data is from HIM? - ANS20%
What % of the UB-04 source of data is from billing? - ANS20%
What % of the UB-04 source of data is not used? - ANS9%
What % of the CMS 1500 source of data is from pt access? - ANS53%
, What % of the CMS 1500 source of data is from service? - ANS14%
What % of the CMS 1500 source of data is from HIM - ANS7%
What % of the CMS 1500 source of data is from billing? - ANS26%
From whom is the UB-04 directed? - ANSinstitutional: hospitals, SNF, hospice
From whom is the CMS 1500? - ANSnon-institutional: physicians, DME
In the FDCA, what is Title I - ANSTruth in Lending Act
What is the Truth in Lending Act - ANS5 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? - ANScreditors can be sued
Who enforces the FDCA for hospitals? - ANSFTC
In the FDCA, what is Title III - ANSlimits garnishments
In the FDCA, what is Title IV - ANSFair Credit Reporting Act
What is the Fair Credit Reporting Act? - ANSprovides consumer rights in reporting loans
Are there rules for how a debt collector communicates with debtor? - ANSYes, eg no profane
language, can't contact before 8 AM
Is a newborn a scheduled or unscheduled pt - ANSunscheduled
What are the three types of pt access incoming to a HCO? - ANSscheduled, unscheduled,
recurring
What is LCD - ANSlocal coverage determinants, in absence of NCD, LCD dtermines whether
-Care will pay for an item or service
What is NCD - ANSnational coverage determinants:' nationwide determination of whether
Medicare will pay for an item or service
What % of pts should be pre-registered of all scheduled pts? - ANS98%
What is the code for HIPAA transaction set for HC eligibility and benefit responses - ANS270
outgoing
