AAHAM CRCS-I Test Questions With Correct Answers

Identify federal agencies playing a major role in healthcare - Answer Department of Health and Human Services (BHHS) and Centers for Medicare and Medicaid Services (CMS) General provisions of major federal regulations - Answer Patient rights, Affordable care, Anti-Fraud and abuse, Credit and Collections, Regulation 501, Patient anti-dumping, Laboratory licensing, and other areas addressed by HIPAA Roles of The Joint Commission - Answer Accreditation as requirement of participation in Medicare Areas in which Patient Access can expect TJC surveys Contingency plan requirements Primary Functions and Responsibilities for Patient Access Representative - Answer Scheduling, Pre-registration and pre-admission testing, pre-certification and pre-authorization, Inpatient admitting and outpatient registration, insurance verification, and Financial counseling Different levels of patient care - Answer acute inpatient, observation, outpatient, long term care, skilled nursing facility, hospice care, respite care, custodial care, home health care, office care Types of Consent - Answer Consent forms and emancipation Types of Consent - Answer Actual or expressed consent, Implied consent- in fact, implied consent- by law, informed consent Types of Insurance - Answer Medicare, Medigap, Medicaid, Worker's Comp, Tricare, Children's Health Insurance Program, Self-Insurance, and Insurance Payer Contracts Payment Methodologies - Answer Diagnosis- Related Group (DRG), Ambulatory Payment Classification (APC), Critical Access Hospital (CAH), Resource Utilization Group (RUG), Capitation, and Per Diem Common or Required Billing and Statement "forms" - Answer Superbill, UB-04, CMS 1500, Itemized Statement, Data Mailer, and Explanation of Benefits (EOB) Acute Inpatient - Answer A level of healthcare delivered to patients experiencing acute illness or trauma Outpatient - Answer Treatment received at a hospital, clinic, or dispensary by someone who is not hospitalized Long Term Care - Answer Care generally provided to the chronically ill or disabled in a nursing facility or rest home Skilled Nursing Facility (SNF) - Answer A SNF can be a separate wing of a hospital, a nursing home, or a freestanding facility. Hospice Care - Answer Coordinated, palliative care provided to terminally ill patients and their families by nonprofit organizations