Professional (CRCP) Terms 2026 Expert
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3-Day Rule - 🧠 ANSWER ✔✔a requirement that all diagnostic or outpatient
services furnished in connection with the principle admitting diagnosis
within three days prior to the hospital admission are bundled with the
inpatient services for Medicare billing
837I - 🧠 ANSWER ✔✔the American National Standards Institute
transaction for an institutional claim; as a result of HIPAA, it is replacing the
electronic UB-04.
,837P - 🧠 ANSWER ✔✔a former American National Standards Institute
transaction for a professional claim (the electronic equivalent of the CMS
15000), since replaced by the 5010A1
838 - 🧠 ANSWER ✔✔quarterly Medicare Credit Balance Report
CMS 1450 - 🧠 ANSWER ✔✔another name for the UB-04 Uniform Bill form.
CMS 1500 - 🧠 ANSWER ✔✔the billing form used to submit physician and
professional service claims to Medicare.
ABN - 🧠 ANSWER ✔✔Advance Beneficiary Notice of Noncoverage; a form
given to a Medicare beneficiary before services are furnished when a
service does not meet or is not expected to meet medical necessity.
Abuse - 🧠 ANSWER ✔✔the misuse of a person, substance, service, or
financial matter such that harm is caused; some forms of healthcare abuse
include excessive or unwarranted use of technology, pharmaceuticles, and
services; abuse of authority; and abuse of privacy, confidentiality, or duty to
care; it also includes improper biling practices (like billing Medicare instead
of primary insurur),increasing charges to Medicare beneficiaries but not to
other patients, unbundling of servies, and unnecessary transfers of
patients.
,Accounts Receivable (AR) Days Outstanding - 🧠 ANSWER ✔✔an estimate,
using average current revenues, of the days required to turn over the
accounts receivable under normal operating conditions; in simple terms,
this is an estimate of the time needed to collect the accounts receivable.
Accrual - 🧠 ANSWER ✔✔a method of accounting in which income is
recognized at the time it is earned, even if not yet collected, and expenses
are booked as they are incurred, even if not yet paid.
ADA - 🧠 ANSWER ✔✔Americans with Disabilities Act; a law passed in
1990 that requires employers to make reasonable adjustments to the work
site to accommodate a disabled employee's ability to perform the job and
requires buildings to be accessible to those with disabilities.
ADC - 🧠 ANSWER ✔✔Average Daily Census; the average number of
inpatients maintained in the hospital each day for a specific period of time.
ALOS - 🧠 ANSWER ✔✔Average length of Stay; a metric calculated by
dividing the total number of patient days by the number of discharges.
Ambulatory Payment Classification - 🧠 ANSWER ✔✔a payment
methodology that places outpatient services into groups based on similar
procedures and resource use.
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, Americans with Disabilities Act - 🧠 ANSWER ✔✔a law passed in 1990 that
requires employers to make reasonable adjustments to the work site to
accommodate a disabled employee's ability to perform the job and requires
buildings to be accessible to those with disabilities.
Anticipated value of AR - 🧠 ANSWER ✔✔AR balance less the average
deduction from revenue, based on the historical deduction from revenue
rate.
Anti-Kickback Statute - 🧠 ANSWER ✔✔a law that prohibits offering free or
discounted services to a physician associated with, or who refers patients
to, another healthcare facility.
APC - 🧠 ANSWER ✔✔Ambulatory Payment Classification; a payment
methodology in which services paid under the prospective payment system
are classified into groups that are similar clinically and in terms of the
resources they require; a payment rate is established for each APC.
AR - 🧠 ANSWER ✔✔accounts receivable.
AR Days - 🧠 ANSWER ✔✔Days a measure of how long, on average, it
takes to collect revenue from the date of discharge.