AAHAM CRCS-P Study Guide With Complete Solution

CRCS - Answer Certified Revenue Cycle Specialist AAHAM - Answer The American Association of Healthcare Administrative Management 1-Day Rule - Answer a requirement that all diagnostic or outpatient services furnished in connection with the principle admitting diagnosis within one day prior to the hospital admission are bundled with the inpatient services for Medicare billing. 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. 5010A1 - Answer the American National Standards Institute transaction for a professional claim (the electronic equivalent of the CMS 15000), formerly the 837P 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), sincereplaced by the 5010A1. ABN - Answer the 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, pharmaceuticals, and services; abuse of authority; and abuse of privacy, confidentiality, or duty to care; it also includes improper billing practices (like billing Medicare instead of primary insurer), increasing charges to Medicare beneficiaries but not to other patients, unbundling of services, 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. ACF - Answer Administration for Children and Families; one of the DHHS Operating Divisions. ACL - Answer Administration for Community Living; one of the DHHS Operating Divisions. actual or expressed consent - Answer written or oral agreement by the patient to the treatment outlined. acute inpatient - Answer a level of healthcare delivered to patients experiencing acute illness or trauma; it generally occurs in a hospital or emergency room and is generally short-term care rather than long-term or chronic care. ADC - Answer average daily census; the average number of inpatients maintained in the hospital each day for a specific period of time. ADRR - Answer Average Days of Revenue in Accounts Receivable; also known as Accounts Receivable (AR) Days Outstanding; 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. Advance Beneficiary Notice - Answer the 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. AFDC - Answer Aid to Families with Dependent Children; a financial assistance program provided by DHHS. agents - Answer individuals who help consumers and small businesses complete the application process and enroll in healthcare coverage through the Marketplace; they are able to make recommendations about coverage and may only sell plans from specific health insurance companies. AHA - Answer the American Hospital Association. AHRQ - Answer Agency for Healthcare Research and Quality; one of the DHHS Operating Divisions. ALOS - Answer average length of stay; a metric calculated by dividing the total number of patient days by the number of discharges. ancillary services - Answer services other than routine room and board charges that are incidental to the hospital stay; they include operating room; anesthesia; blood administration; pharmacy; radiology; laboratory; medical, surgical, and central supplies; physical, occupational, speech pathology, and inhalation therapies; and other diagnostic services. ANSI - Answer the American National Standards Institute. 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. APR - Answer annual percentage rate; one of the elements of disclosure required by the Truth in Lending Act. assignment of benefits - Answer a written authorization, signed by the policyholder (or the patient, in the absence of the policyholder) to an insurance company, to pay benefits directly to the provider; when assignment is not accepted, the payment will be sent to the patient and the provider will have to collect it. ATB - Answer aged trial balance; a resource for internal collection efforts. ATSDR - Answer Agency for Toxic Substances and Disease Registry; one of the DHHS Operating Divisions. average daily census - Answer the average number of inpatients maintained in the hospital each day for a specific period of time. average daily revenue - Answer the average amount of revenue or charges generated each day over a specified period of time. Average Days of Revenue in Accounts Receivable - Answer also known as Accounts Receivable (AR) Days Outstanding; 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. bad debt - Answer an uncollectible account resulting from the extension of credit. beneficiary - Answer a person who has healthcare insurance through Medicare birthday rule - Answer a rule to determine coordination for benefits for a child covered by both parents; it dictates that the parent with the first birthday in the calendar year will provide the primary coverage; if both parents happen to have the same birthday, the plan that has covered a parent longer pays first. Black Lung Benefits Act - Answer legislation which provides for medical treatment for coal miners totally disabled from black lung disease. Bressers - Answer a cross-reference directory used in skip tracing. brokers - Answer individuals who help consumers and small businesses complete the application process and enroll in healthcare coverage through the Marketplace; they are able to make recommendations about coverage and may only sell plans from specific health insurance companies. CAH - Answer Critical Access Hospital Call centers - Answer an option for consumers to ask questions about health coverage options and obtain assistance with the Marketplace application process. capitation - Answer a method of payment in which a provider is paid a set dollar amount for each patient for a specific time period, and that payment covers all care the group of patients receives for that period, no matter the actual charges. Case Management - Answer also known as Utilization Review (UR); an area that performs critical tasks during registration and a patient's stay, such as reducing unnecessary admissions; managing the approved length of stay; ensuring an appropriate level of care for the patient's condition; serving as liaison with the primary and specialty physicians; serving as liaison with the insurance carrier; obtaining approvals, when clinically necessary, for pre-certification/re-certification; advising the patient of discharge; and assisting with appeals for denials, when applicable. CDC - Answer Centers for Disease Control and Prevention; one of the DHHS Operating Divisions. CDM - Answer charge description master; the chargemaster or master pricing list that includes services, supplies, devices, and medication charges for inpatient or outpatient services by a healthcare facility. CERT - Answer Comprehensive Error Rate Testing. Certified application counselors - Answer individuals (staff members or volunteers) who fulfill some of the same roles as Navigators and non-Navigators; they are not responsible for outreach and education but they do provide free information to consumers about insurance programs, they assist them in applying for coverage, and they help to facilitate the enrollment in health coverage. CHAMPUS - Answer Civilian Health and Medical Programs of the Uniformed Services; the programs replaced by Tricare to cover healthcare for active duty and retired members of the uniformed services, their families, and survivors. Chapter 7 - Answer a type of bankruptcy applying to individuals and businesses that cannot pay their debts based on their income; except for exempt property as defined by state laws, the debtor's assets are auctioned to satisfy creditor claims; about 70% of all bankruptcy claims are filed under Chapter 7. Chapter 11 - Answer a type of bankruptcy frequently referred to as a "reorganization"; it gives a distressed business a reprieve from creditor claims while it continues to function and works out a repayment plan. Chapter 12 - Answer a type of bankruptcy for a family farmer with "regular annual income." Chapter 13 - Answer a type of bankruptcy designed for individuals with regular income who desire to pay their debts, but currently are unable to do so; the debtor, under court supervision and protection, may propose and carry out a repayment plan under which creditors are paid over an extended period of time. chargemaster - Answer also known as charge description master (CDM); the master pricing list that includes services, supplies, devices, and medication charges for inpatient or outpatient services by a healthcare facility. charity care - Answer service provided that is never expected to result in cash SCHIP - Answer the Children's Health Insurance Program; a program for children whose parents have too much money to be eligible for Medicaid, but not enough to buy private insurance; it is jointly financed by the federal and state governments, and administered by the states. CLIA - Answer the Clinical Laboratory Improvement Amendment of 1988; legislation requiring all clinical laboratory services furnished to Medicare beneficiaries to be performed by a provider who has a CLIA certificate. Clinical Laboratory Improvement Amendment (CLIA) of 1988 - Answer legislation requiring all clinical laboratory services furnished to Medicare beneficiaries to be performed by a provider who has a CLIA certificate. CMP - Answer civil monetary penalty. CMS - Answer Centers for Medicare and Medicaid Services; one of the DHHS Operating Divisions. 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. CO - Answer compliance officer. COB - Answer coordination of benefits; the determination of which plan or insurance policy will pay first if two health plans or insurance policies cover the same benefits.