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