2024 CRCR Exam 2 New Full Exam Questions and Answers ( Included ) 100% Correct
- What do Case Managers do?
Answer: Monitor high resource cases to ensure effective utilization
- What is HIM responsible for?
Answer: all pt medical records: transcribe, coding, release to biling, answer requests for documentation
- What is utilization management responsible for?
Answer: manage cases: services correct, on time
- What are the three types of utilization review?
Answer: Prospective, Concurrent, Ret rospective
- Where can home health services be offered?
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?
Answer: A transfer agreement approved by -Care.
- Can a home health agency employ another agency to provide services?
Answer: - Yes, so long as at least one employee of the original agency provides
care.
- What is the Net Collection Rate?
Answer: how much cash was collected as a % of available to collect?
- What is the Net Collection Rate benchmark?
Answer: 95%
- What is the benchmark for denials
Answer: <2% on first submission
- Formual for cost to collect
Answer: total PFS expenses/gross pt care collections
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- What is the benchmark for cost to collect
Answer: 2.25%
- What % of the UB-04 source of data is from pt access?
Answer: 40%
- What % of the UB-04 source of data is from service depts?
Answer: 11%
- What % of the UB-04 source of data is from HIM?
Answer: 20%
- What % of the UB-04 source of data is from billing?
Answer: 20%
- What % of the UB-04 source of data is not used?
Answer: 9%
- What % of the CMS 1500 source of data is from pt access?
Answer: 53%
- What % of the CMS 1500 source of data is from service?
Answer: 14%
- What % of the CMS 1500 source of data is from HIM
Answer: 7%
- What % of the CMS 1500 source of data is from billing?
Answer: 26%
- From whom is the UB-04 directed?
Answer: institutional: hospitals, SNF, hospice
- From whom is the CMS 1500?
Answer: non-institutional: physicians, DME
- In the FDCA, what is Title I
Answer: Truth in Lending Act
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