AAHAM Certified Revenue Cycle Professional (CRCP) Terms - 2015 (KD) Exam Questions With Correct Answers

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. 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. Asset - Answer control procedures to protect assets from theft. Assets, those things a business owns that have a value. 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 direcly to the provider; when assignment is not accepted, the payment wil be sent to the patient and the provider will have to collect it. Automated - Answer a type of review in which RAC identifies a potential issue and uses its database to find improper payments; the provider is then given notification of denied claims. Average daily census - Answer the average number of inpatients maintained in the hospital each day for a specific period of time. Average length of stay - Answer the total number of patient days divided by the number of discharges. Bad debt - Answer a deduction from revenue when an account is determined to be uncollectible. Balance sheet - Answer a financial statement that is a snapshot in time of the business. Bankruptcy - Answer a legal proceeding taken when the debts of an individual or company far exceed the assets, and there is presumably no reasonable hope of repayment. bill hold days - Answer the number of days a bill sits before a claim drops CAH - Answer Critical Access Hospital; a non-profit hospital located in a state that has established a Medicare Rural Hospital Flexibility Program; it must have 25 or fewer beds and an ALOS of 96 hours or less, be located a certain minimum distance from other hospitals, and furnish 24-hour emergency care services; Medicare pays CAH"S for most inpatient and outpatient services on the basis of reasonable cost. Capital - Answer the kind of asset that cannot be-easily turned into cash, such as land, buildings, and large equipment. 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. Cash flow statement - Answer one of four common financial statements; the others are the balance sheet, income statement, and changes in fund balances statement. Cash - Answer a method of accounting in which income is recognized when it is collected and expenses are booked when they are paid. Certificate for Provider Performed Microscopy - Answer one of the five types of CLIA certificates; each is valid for two years. Certificate of Accreditation - Answer one of the five types of CUA certificates; each is valid for two years. Certificate of Compliance - Answer one of the five types of CLIA certificates; each is valid for two years. Certificate of Registration - Answer one of the five types of CLIA certificates;each is valid for two years. Certificate of Waiver - Answer one of the five types of CUA certificates; each is valid for two years. Changes infund balances statement - Answer one of four common financial statements; the others are the balance sheet, income statement, and cash flow statement. 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 creditors claims; about 7% of all bankruptcy claims are filed under Chapter 7. 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 debtors, 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. Children's Health Insurance Program - Answer a state and federal partnership created in 1997 that targets uninsured children and pregnant women in families with incomes too high to qualify for most state Medicaid programs, but often too low to afford private coverage. CHIP - 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 government, and administered by the states. CLIA - Answer Clinical Laboratory Improvement Amendment of 1988; legislation requiring all clinical laboratory services furnished to Medicare beneficiaries to be performed by the provider who has a CLIA certificate. Clinical Laboratory Improvement Amendment of 1988 (CLIA) - Answer legislation requiring all clinical laboratory services furnished to Medicare beneficiaries to be performed by a provider who has a CLIA certificate. CMHC - Answer community mental health center. CMS - Answer Centers for Medicare and Medicaid Services; formerly the Health Care Financing Administration (HCFA), was established in 1977 to administer the two national healthcare programs, the mission of CMS is to ensure effective, up-to-date healthcare coverage and promote quality care for beneficiaries. 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. Coinsurance - Answer the percentage of allowable charges which the patient must pay after paying his or her deductible. / The insured pays a share of the payment made against a claim. Commercial insurance - Answer health insurance that covers individuals; most often obtained as a benefit of employment, individual policies can be purchased by people who do not get insurance through an employer. Complex - Answer a type review in which RAC requests medical records and makes its determination from them. Conditional Payment - Answer a payment made when another payer is responsible, but the claim is not expected to be paid promptly (usually within 120 days from receipt of the claim); it prevents the beneficiary from having to pay out of pocket; Medicare then has the right to recover any payments that should have been made by another payer. Conflict of interest - Answer a situation where one or more parties to an arrangement have an opportunity to exploit their position for personal or business advantage. Conservator - Answer an individual appointed by a court to handle the affairs of another person who is incapable of caring for him- or herself. coordination of benefits - Answer the process of determining which plan or insurance policy will pay first if two health plans or insurance policies cover the same benefits. Cost to Collect - Answer the percentage of total costs to the total dollar amount received. courtesy discharge - Answer a type of discharge in which a patient's financial considerations have been met so he or she is allowed to leave the hospital without going through the usual formalities; the patient is billed at a later date. Coverage percentage - Answer the percentage at which a payer will reimburse the provider; also called the reimbursement rate. CPT - Answer Current Procedural Terminology; a system of terms and five-digit numeric codes that are used primarily to identify medical services and procedures furnished by physicians and other healthcare prof essionals. Critical Access Hospital (CAH) - Answer a non-profit hospital located in a state that has established a Medicare Rural Hospital Flexibility Program; it must have 25 or fewer beds and an ALOS of 96 hours or less, be located a certain minimum distance from other hospitals, and furnish 24-hour emergency care services; Medicare pays CAH's for most inpatient and outpatient services on the basis of reasonable cost. Current liabilities - Answer those things that a business owes and are expected to be settled in cash within one year, such as wages, taxes, and accounts payable. CWF - Answer Common Working File data mailer - Answer a system-generated, free-form statement that is used to communicate the status of a patient's account and/or to bill the patient for an unpaid amount remaining on the account. Days Cash on Hand - Answer a calculation to indicate how long an entity could keep paying bills if money stopped coming in. Debits and credits - Answer entries that increase or decrease the balance of various accounts. Deductible - Answer an amount that a patient must pay for healthcare before the payer begins to pay. Diagnosis-Related Group - Answer a group of services that has a payment weight assigned to it, based on the average resources used to treat Medicare Discharge of Debtor - Answer a potential outcome of bankruptcy that releases the gaurantor / patient from financial responsibility of any and all account balances listed on the bankruptcy petition; the account balance is to be written off to the appropriate transaction code. discharged not final billed - Answer an account where the patient has completed treatment but, for various reasons, has not had a claim produced. Dismissal - Answer a court ruling whereby a bankruptcy is rejected by the court; the most common reason for dismissal is the failure of the debtor to follow through on the filing process and on payment to the attorney, and failure to provide requested documentation; upon dismissal of a bankruptcy, a creditor can bill the debtor directly, refer the account to a collection agency, or pursue litigation. DME - Answer Durable Medical Equipment; medical equipment that can withstand repeated use, such as wheelchairs, hospital beds, oxygen and walkers. DMEPOS - Answer Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. DNFB - Answer Discharged not Final Billed; an account for a patient who has completed treatment but has not had a claim produced, Or, accounts that are not yet billed at the time of discharge DNR - Answer Do Not Resuscitate; a document that states that the patient does not wish to have CPR or similar interventions performed in the event of a medical emergency. DRG - Answer Diagnosis-related group; Is a system to classify hospital cases / A group of services that has a payment weight assigned to it, based on the average resources used to treat Medicare patients. Durable Power of Attorney for Healthcare - Answer also known as Healthcare Power of Attorney; a document that designates someone else (known as a healthcare surrogate, agent, or proxy) to make decisions on the patient's behalf if he/she is unable to do so. E&M - Answer Evaluation and Management; both the process of and the charge for examining a patient and formulating a treatment plan. ED - Answer Emergency department. EHR - Answer electronic health record. Emancipation - Answer a process by which a minor is freed from parental control based on specific criteria (the minor no longer requires parental guidance or financial support, fathered or gave birth to a child, or has reached the age of majority)