CRCR Exam Prep with all Correct & 100% Verified
Answers|2025/2026 Latest Update| Already Graded A+
(Just Released)
What do Case Managers do? ✔Correct Answer--Monitor high resource cases to ensure effective
utilization
What is HIM responsible for? ✔Correct Answer--all pt medical records: transcribe, coding, release
to biling, answer requests for documentation
What is utilization management responsible for? ✔Correct Answer--manage cases: services
correct, on time
What are the three types of utilization review? ✔Correct Answer--Prospective, Concurrent,
Retrospective
Where can home health services be offered? ✔Correct Answer--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? ✔Correct
Answer--A transfer agreement approved by -Care.
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.
What is the Net Collection Rate? ✔Correct Answer--how much cash was collected as a % of
available to collect?
What is the Net Collection Rate benchmark? ✔Correct Answer--95%
What is the benchmark for denials ✔Correct Answer--<2% on first submission
Formual for cost to collect ✔Correct Answer--total PFS expenses/gross pt care collections
What is the benchmark for cost to collect ✔Correct Answer--2.25%
What % of the UB-04 source of data is from pt access? ✔Correct Answer--40%
What % of the UB-04 source of data is from service depts? ✔Correct Answer--11%
What % of the UB-04 source of data is from HIM? ✔Correct Answer--20%
What % of the UB-04 source of data is from billing? ✔Correct Answer--20%
What % of the UB-04 source of data is not used? ✔Correct Answer--9%
What % of the CMS 1500 source of data is from pt access? ✔Correct Answer--53%
, What % of the CMS 1500 source of data is from service? ✔Correct Answer--14%
What % of the CMS 1500 source of data is from HIM ✔Correct Answer--7%
What % of the CMS 1500 source of data is from billing? ✔Correct Answer--26%
From whom is the UB-04 directed? ✔Correct Answer--institutional: hospitals, SNF, hospice
From whom is the CMS 1500? ✔Correct Answer--non-institutional: physicians, DME
In the FDCA, what is Title I ✔Correct Answer--Truth in Lending Act
What is the Truth in Lending Act ✔Correct Answer--5 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? ✔Correct Answer--creditors can be sued
Who enforces the FDCA for hospitals? ✔Correct Answer--FTC
In the FDCA, what is Title III ✔Correct Answer--limits garnishments
In the FDCA, what is Title IV ✔Correct Answer--Fair Credit Reporting Act
What is the Fair Credit Reporting Act? ✔Correct Answer--provides consumer rights in reporting
loans
Are there rules for how a debt collector communicates with debtor? ✔Correct Answer--Yes, eg no
profane language, can't contact before 8 AM
Is a newborn a scheduled or unscheduled pt ✔Correct Answer--unscheduled
What are the three types of pt access incoming to a HCO? ✔Correct Answer--scheduled,
unscheduled, recurring
What is LCD ✔Correct Answer--local coverage determinants, in absence of NCD, LCD dtermines
whether -Care will pay for an item or service
What is NCD ✔Correct Answer--national 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? ✔Correct Answer--98%
What is the code for HIPAA transaction set for HC eligibility and benefit responses ✔Correct
Answer--270 outgoing
271 response
What are some payer data elements needed to process payment? ✔Correct Answer--policy type,
covered persons, mail address, cvr type (HMO), deductible
What is an PPO ✔Correct Answer--closest to indemnity plan, only preferred doctors in network get
contracted prices
Answers|2025/2026 Latest Update| Already Graded A+
(Just Released)
What do Case Managers do? ✔Correct Answer--Monitor high resource cases to ensure effective
utilization
What is HIM responsible for? ✔Correct Answer--all pt medical records: transcribe, coding, release
to biling, answer requests for documentation
What is utilization management responsible for? ✔Correct Answer--manage cases: services
correct, on time
What are the three types of utilization review? ✔Correct Answer--Prospective, Concurrent,
Retrospective
Where can home health services be offered? ✔Correct Answer--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? ✔Correct
Answer--A transfer agreement approved by -Care.
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.
What is the Net Collection Rate? ✔Correct Answer--how much cash was collected as a % of
available to collect?
What is the Net Collection Rate benchmark? ✔Correct Answer--95%
What is the benchmark for denials ✔Correct Answer--<2% on first submission
Formual for cost to collect ✔Correct Answer--total PFS expenses/gross pt care collections
What is the benchmark for cost to collect ✔Correct Answer--2.25%
What % of the UB-04 source of data is from pt access? ✔Correct Answer--40%
What % of the UB-04 source of data is from service depts? ✔Correct Answer--11%
What % of the UB-04 source of data is from HIM? ✔Correct Answer--20%
What % of the UB-04 source of data is from billing? ✔Correct Answer--20%
What % of the UB-04 source of data is not used? ✔Correct Answer--9%
What % of the CMS 1500 source of data is from pt access? ✔Correct Answer--53%
, What % of the CMS 1500 source of data is from service? ✔Correct Answer--14%
What % of the CMS 1500 source of data is from HIM ✔Correct Answer--7%
What % of the CMS 1500 source of data is from billing? ✔Correct Answer--26%
From whom is the UB-04 directed? ✔Correct Answer--institutional: hospitals, SNF, hospice
From whom is the CMS 1500? ✔Correct Answer--non-institutional: physicians, DME
In the FDCA, what is Title I ✔Correct Answer--Truth in Lending Act
What is the Truth in Lending Act ✔Correct Answer--5 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? ✔Correct Answer--creditors can be sued
Who enforces the FDCA for hospitals? ✔Correct Answer--FTC
In the FDCA, what is Title III ✔Correct Answer--limits garnishments
In the FDCA, what is Title IV ✔Correct Answer--Fair Credit Reporting Act
What is the Fair Credit Reporting Act? ✔Correct Answer--provides consumer rights in reporting
loans
Are there rules for how a debt collector communicates with debtor? ✔Correct Answer--Yes, eg no
profane language, can't contact before 8 AM
Is a newborn a scheduled or unscheduled pt ✔Correct Answer--unscheduled
What are the three types of pt access incoming to a HCO? ✔Correct Answer--scheduled,
unscheduled, recurring
What is LCD ✔Correct Answer--local coverage determinants, in absence of NCD, LCD dtermines
whether -Care will pay for an item or service
What is NCD ✔Correct Answer--national 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? ✔Correct Answer--98%
What is the code for HIPAA transaction set for HC eligibility and benefit responses ✔Correct
Answer--270 outgoing
271 response
What are some payer data elements needed to process payment? ✔Correct Answer--policy type,
covered persons, mail address, cvr type (HMO), deductible
What is an PPO ✔Correct Answer--closest to indemnity plan, only preferred doctors in network get
contracted prices
