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Exam (elaborations)

CRCR 2024/2025 A+ score assured

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  • Course
  • Certified Revenue Cycle Representative CRCR
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  • Certified Revenue Cycle Representative CRCR

CRCR 2024/2025 A+ score assured

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  • April 18, 2024
  • 10
  • 2023/2024
  • Exam (elaborations)
  • Questions & answers
  • Certified Revenue Cycle Representative CRCR
  • Certified Revenue Cycle Representative CRCR
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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

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