CRCS CERTIFICATION EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+

1 CRCS CERTIFICATION EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+ CMS Correct Answer: Centers for Medicare and Medicaid Services and also one of the HHS operating divisions OIG Correct Answer: Office of Inspector General in DHHS. Monitors compliance with reimbursement laws & regulations Title XVIII Correct Answer: Medicare Title XIX Correct Answer: Medicaid HIPAA Correct Answer: Health Insurance Portability and Accountability Act HHS 2 Correct Answer: Department of Health & Human Services. And has 11 operating divisions NIH Correct Answer: National Institutes of Health; one of the HHS Operating Divisions. FDA Correct Answer: Food and Drug Administration - one of the HHS operating divisions CDC Correct Answer: Center for Disease Control and prevention; one of the HHS operating divisions ATSDR Correct Answer: Agency for Toxic Substances and Disease Registry; one of the DHHS Operating Divisions. IHS Correct Answer: Indian Health Service; one of the DHHS Operating Divisions. HRSA Correct Answer: Health Resources and Services Administration; one of the HHS Operating Divisions. 3 AHRQ Correct Answer: Agency for Healthcare Research and Quality; one of the HHS operating divisions QIO Correct Answer: Quality Improvement Organization; part of a CMS program to monitor and improve utilization and quality of care for Medicare beneficiaries. ACF Correct Answer: Administration for Children and Families; one of the DHHS Operating Divisions. ACL Correct Answer: Administration for Community Living; one of the DHHS Operating Divisions. AHA Correct Answer: American Hospital Association Patient Bill of Rights Correct Answer: Adopted in 1970s, states expectations that patients and their families can have about how they will be treated in healthcare situations 4 Patient Care Partnership Correct Answer: Replacing the AHA's Patients' Bill of Rights, this plain language brochure informs patients about what they should expect during their hospital stay with regard to their rights and responsibilities. 1-day payment window rule Correct Answer: a Medicare requirement similar to the 3-day payment window rule that applies to inpatient psychiatric hospitals, inpatient rehabilitation facilities, long term care facilities, and children's and cancer hospital. 3-day payment window rule Correct Answer: a Medicare requirement that all diagnostic and clinically related nondiagnostic outpatient services provided within three days of an inpatient admission must be combined to the inpatient claim when they are provided by an entity wholly owned or operated by the inpatient hospital (or by another entity under arrangements with the admitting hospital) 837I Correct Answer: the dataset that is utilized to electronically submit hospital claims to the payer. 837P 5 Correct Answer: the billing form used to electronically submit physician and professional service claims to the payer ABN Correct Answer: Advanced Beneficiary Notice of non-coverage; 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 Correct Answer: Incidents or practices of healthcare workers that although not unusually considered fraudulent are and inconsistent with accepted sound practices Accounts receivable (AR) days outstanding Correct Answer: another name for Average Days of Revenue in Accounts Receivable (ADRR); 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. Actual or expressed consent Correct Answer: written or oral agreement by the patient to the treatment outlined. ADC 6 Correct Answer: Average daily census; the average number of inpatient maintain in the hospital each day for a specific period of time Total Number of Patient days / Number of Days = ADC ADRR Correct 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. ALOS Correct Answer: average length of stay; a metric calculated by dividing the total number of patient days by the number of discharges. Total number of Patient Days/Number of Discharges = ALOS APC Correct Answer: Ambulatory payment classification; a payment methodology in which services paid under the perspective payment system are classified into groups that are similar clinically and in terms of resources they require; a payment rate is established for each APC 7 APR Correct Answer: Annual Percentage Rate; One of the elements of disclosure required by the truth in lending act Assignment of benefits Correct Answer: Written authorization signed by the policyholder to an insurance company to pay benefits directly to the provider when assignment is not excepted the payment will be sent to the patient and the provider will have to collect it ATB Correct Answer: aged trial balance; a resource for internal collection efforts. Average Daily Census (ADC) Correct Answer: The average number of inpatients maintained in the hospital each day for a specific period of time Average daily revenue Correct Answer: The average amount of revenue or charges generated each day for a specific period of time Average Days of Revenue in Accounts Receivable Correct Answer: also known as Accounts Receivable (AR) Days Outstanding; an estimate, using average current revenues, of the days required to turn over the 8 accounts receivable under normal operating conditions; in simple terms, this is an estimate of the time needed to collect the accounts receivable. bad debt Correct Answer: An uncollectible account resulting from an extension of credit beneficiary Correct Answer: A person who has health care insurance through Medicare Birthday rule Correct Answer: A rule to determine coordination for benefits for a child covered by both parents dictates that the parent with the first birthday in the calendar year it 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 (BLBA) Correct Answer: Legislation that established the federal black lung program for individuals who have been diagnosed with pneumoconiosis or black lung disease Capitation Correct 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 receive for that period. No matter the actual charges 9 case management Correct Answer: Also known as utilization review (UR) an area that performs critical tasks during registration and patients stay Chapter 7 Bankruptcy Correct 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 debtors assets are auctioned to satisfy creditor claims; about 70% of all bankruptcy claims are filed under this chapter Chapter 11 Bankruptcy Correct Answer: A type of bankruptcy frequently referred to as "re-organization"; it gives a distressed business a reprieve from creditor claims while it continues to function and works out a repayment plan Chapter 12 Bankruptcy Correct Answer: A type of bankruptcy for a family farmer with "regular annual income" Chapter 13 Bankruptcy Correct 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 10 supervision and protection, may propose and carry out repayment plan under which creditors are paid over an extended period of time Charge master or CDM (charge description master) Correct Answer: An electronic file that resides in the providers information system and that contains charges that can be posted to a patient account Charity Care Correct Answer: Service provided that is never expected to result in cash flow; it results from the providers policy to provide healthcare services free of charge or at a reduced cost to individuals who meet certain financial criteria CHIP Correct Answer: Children's Health Insurance Program also known as title XXI for children whose families failed to qualify for Medicaid but cannot afford to purchase private insurance; jointly financed by the federal and state governments in administered by the states Clinical Laboratory Improvement Amendments (CLIA) Correct Answer: Legislation requiring all clinical laboratory services furnished to Medicare beneficiaries to be performed by a provider who has a CLIA certificate CMP 11 Correct Answer: Civil Monetary Penalty CMS-1450 Correct Answer: Another name for the UB04 for uniform bill form CMS-1500 Correct Answer: The paper billing form used to submit physician and professional service claims to Medicare CO Correct Answer: Compliance officer; one of the OIG seven elements of compliance plan COB Correct Answer: coordination of benefits Commercial Insurance Correct Answer: health insurance that covers individuals, usually as an employment benefit but also purchased as an individual policy. Common Working File (CWF) Correct Answer: a CMS file that contains Medicare patient eligibility and utilization data Conditional payment 12 Correct Answer: A payment made when another pair is responsible, but the claim is not expected to be paid properly (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 pair Courtesy discharge Correct 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 CPT Correct Answer: Current procedural terminology; a system of descriptive terms and five digit numeric codes that are used primarily to identify medical services and procedures finished by physicians and other healthcare professionals Critical Access Hospital (CAH) Correct Answer: A small hospital that serves a rural community; maintains no more than 25 inpatient beds that may be used for swing bed services; may operate A distinct part rehabilitation/psychiatric unit each with up to 10 beds; has an ALOS of 96 hours or less per patient for acute care is located more than a 35 mile drive from any hospital or CAH in any area with mountainous terrain or only secondary roads; it furnishes 24/7 care emergency care 13 Custodial Care Correct Answer: help with bathing, dressing, toileting, and eating. data mailer Correct 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. definitive LCD/NCD Correct Answer: a policy that discusses and lists specific diagnosis codes, ICD procedure codes, and possibly signs and symptoms to support the need for the item or service being given. Discharge of debtor Correct Answer: a potential outcome of bankruptcy that releases the guarantor/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. dismissal Correct Answer: A court ruling whereby a bankruptcy is rejected by the court; the most common reason for a dismissal is a failure of the debtor to follow through on the final process and on payment to the attorney and failure to provide requested 14 documentation; upon dismissal of bankruptcy, a creditor can bill the debtor directly, refer to the account to collections agency and pursue litigation DME Correct Answer: durable medical equipment, such as wheelchairs, hospital beds, oxygen, and walkers. DMEPOS Correct Answer: Durable medical equipment, prosthetics, orthotics, and supplies DNR order Correct Answer: Do not resuscitate order; a document stating that the patient does not wish to have CPR or similar interventions performed in the event of a medical emergency DSMT Correct Answer: Diabetes Self-Management Training; a Medicare Part B covered preventive service. Dual eligible Correct Answer: An individual who is entitled to Medicare part A/part B and also eligible for some form of Medicaid benefit 15 ECOA Correct Answer: Equal Credit Opportunity Act; a law that prohibits credit discrimination on the basis of race, color, religion, national origin, sex, marital status, age, or because someone receives public assistance. EGHP Correct Answer: Employer Group Health Plan Emancipation Correct Answer: The process by which a minor is free 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) EMTALA (Emergency Medical Treatment and Active Labor Act) Correct Answer: EMTALA; also known as the federal anti-dumping statute; legislation enacted in response to concerns that hospitals refusing to treat patients without insurance and even transferring them to other facilities and leaving them there, sometimes without notifying the receiving a Facility ER or ED Correct Answer: emergency room or emergency department A level of patient care; patients in the ER are outpatients 16 EOB (explanation of benefits) Correct Answer: Explanation of benefits; a statement sent by a health insurance company to covered individuals explaining what medical treatment/services were paid for on their behalf; similar to an RA; it may or may not have a check attached for payment of services Evaluation and management Correct Answer: (E&M) both the process of and the charge for examining a patient and formulating a treatment plan. Fair Credit Billing Act Correct Answer: Legislation that protects consumers from inaccurate or unfair practices by issuers open ended credit and requires creditors to inform debtors of their rights and of the responsibilities of the creditor Fair Credit Reporting Act Correct Answer: Legislation that defines what information from "consumer reports" can be used by whom and when; it provides the maximum protection of a consumers right to privacy and confidentiality of credit reports Fair Debt Collection Practices Act 17 Correct Answer: Legislation enacted as the result of evidence that debt collectors were using abusive, deceptive, and unfair collection practices; and impose a strict limitation and prohibitions on debt collection practices False Correct Answer: A type of skip generally caused by clerical error at the time of registration, such as transpose numbers in the street address, and incorrect ZIP Code, or incomplete information False Claims Act (FCA) Correct Answer: Legislation that prohibits making a false record or statement to get false/fraudulent claim paid by the government, submission of false/fraudulent claims, and conspiring To have false fraudulent claims paid by the government fee-for-service Correct Answer: The oldest method of payment, in which providers are paid for each medical service rendered to a patient fee schedule Correct Answer: a payment methodology for some outpatient services; the schedule lists CPT and HCPCS codes and what Medicare allows for each, before deductible and coinsurance is applied 18 GAAP Correct Answer: Generally accepted accounting principles; a common set of accounting principles, standards, and procedures that companies must follow when they compile their financial statements gate keeper Correct Answer: The primary care physician or PCP HCPCS Correct Answer: Health care common procedure coding system; a mandated transaction code set for outpatient procedures Health Care Power of Attorney (HCPA) Correct Answer: Also known as durable power of attorney for healthcare; a document that designate someone else to make decisions on the patients behalf if he or she is unable to do so HHS Correct Answer: US Department of health and human services; the governments principle agency for protecting the health of all Americans and providing essential human services HMO 19 Correct Answer: Health maintenance organization; one of five types of Medicare advantage plans in which members miss generally get healthcare providers in the plans network Home health Correct Answer: Limited part-time or intermittent skilled nursing care and home health aide services, physical therapy, occupational therapy, speech-language therapy, medical social services, DME, medical supplies, and other services. Hospice Correct Answer: Coordinated, palliative care provided to terminally ill patients and their families by nonprofit organizations Hospital issued a notice of non-coverage (HINN) Correct Answer: A liability notice similar to an ABN; hospitals give HINNs fee for service inpatient hospital beneficiaries who are due to receive specific diagnostic or therapeutic procedures that are separate from treatment covered/paid /bundled into the inpatient stay HSA Correct Answer: Health savings account; a bank account maintained by a patient to pay medical expenses not covered by insurance; fines and interest in the HSA are not 20 taxed; to have an HSA, the subscriber must be enrolled in a specific, high deductible health plan I-Bill Correct Answer: an itemized statement ICD Correct Answer: International classification of diseases; a mandated transaction codes that used for diagnosis and inpatient procedures ICD-10 Correct Answer: The current version of the international classification of diseases used in the United States IEQ Correct Answer: Initial Enrollment Questionnaire; a questionnaire mailed about three months before patients become entitled to Medicare; it asks about any other healthcare coverage that may be primary to Medicare Implied consent by law Correct Answer: Consent that occurs in a situation where the patient is unconscious and is taken to the emergency room; the law allows treating the patient 21 Implied consent in fact Correct Answer: consent by silence; the patient implies consent to the treatment by not objecting. Important Message from Medicare Correct Answer: a document required to be given by hospitals to all Medicare and Medicare Advantage beneficiaries who are hospital inpatients within two days of admission and again within two days of discharge. Imprest Correct Answer: petty cash Incomplete claim Correct Answer: claim missing required information indigent Correct Answer: An individual who has no means of paying for medical services or treatment and is not eligible for benefits under Medicaid or any other public assistance program Informed consent Correct Answer: Consent given when the risk and benefits of a treatment are understood and the patient makes an informed decision whether to receive treatment; 22 required unless an exception is present, such as a patient incapacity to understand the explanation of the procedures or in an emergency situation situation IPPE Correct Answer: initial preventive physical examination; the "Welcome to Medicare Physical Exam" that is offered to each beneficiary once in a lifetime. Initiation Correct Answer: The beginning of the treatment for a new encounter or a new plan of care; one of triggering events for an ABN Inpatient Correct Answer: A level of healthcare where, on doctors orders, the patient is admitted to a bed with the expectation that the patient will require hospital care that will spend at least two midnights; often called acute care Intentional Correct Answer: A type of skip in which someone avoids paying bills by changing his or her residency and failing to leave a forwarding address, purposefully changing his or her name or intentionally giving false information involuntary bankruptcy 23 Correct Answer: A type of bankruptcy in which a debtor can be placed under chapter 7 or 11 if the debtor has 12 or more creditors, three of which have claims in excess of $5000 each and are willing to force the issue, or one creditor who is owed at least $10,775 IPPS Correct Answer: Inpatient perspective payment system Itemized statement Correct Answer: A complete listing or detailed account of every service posted to a patient account with date of service, description of service, service code, charge amount, estimated insurance amounts, patient payment amounts, and totals TJC Correct Answer: The Joint Commission; a private agency that seeks to protect and improve the quality and safety of care; CMS allows TJC to accredit hospitals; and inspects facilities and provides education on issues affecting patient care and safety TJC will conduct an audit of a hospital every 39 months and of a laboratory every two years. The organization can audit a healthcare facility without advance notice, as early as 9-30 months after its initial audit judgment 24 Correct Answer: A legally verified claim against the debtor validated by the court; a legal right to collect a debt that can be used to obtain a lien Local Coverage Determination (LCD) Correct Answer: policies developed by MACs that specify criteria for services and show under what clinical circumstances an item or service is considered to be reasonable, necessary, and appropriate locum tenens Correct Answer: A temporary substitute especially for a doctor or member of the clergy Liability insurance Correct Answer: Coverage through property and casualty or auto insurance Lien Correct Answer: A recorded claim against real or personal property, generally arising out of a debt; if the property is sold by the debtor, the creditor must be paid out of the proceeds of that sale Limiting charge Correct Answer: The limit on the amount non-participating physicians can charge beneficiaries; currently 115% of the fee schedule amount 25 living will Correct Answer: A document that specifies what treatments a patient does and does not wish to receive; it means that difficult decisions about future care are made by the person is alert; patient can choose the circumstances under which they will die; and patience desires regarding organ donation Are made known LTC Correct Answer: Long-term care generally provided to the chronically ill or disabled in a nursing facility or rest home; among the services provided by nursing facilities are 24 hour nursing care, rehabilitative services, and assistance with daily activities LTR Correct Answer: Lifetime reserve; 60 days of inpatient hospital services that beneficiary can opt to use After having used 90 days of inpatient hospital services and a benefit.; It comes with high coinsurance and can be used only once in the beneficiaries lifetime (but can be split among multiple hospital stays) MAAC Correct Answer: maximum allowable actual charge; it has been replaced by the limiting charge. MAC 26 Correct Answer: Medicare administrative contractor; a private firm that processes Medicare claims; formally known as fiscal Intermediaries or carriers MDC Correct Answer: major diagnostic category; one of 25 groups of DRGs (diagnosisrelated groups). MDS Correct Answer: Minimum data set; part of the federally required process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes; the MDS then determines the RUG and hence the payment Medicaid Correct Answer: A health insurance program also known as title XIX; provides coverage for eligible low income adults, children, pregnant women, elderly adults, and people with disabilities; is administered through a state federal partnership Medicare Correct Answer: A health insurance program known as title XVIII; covers individuals who are elderly age 65 or older or have permanent disabilities, ESRD, or Lou Gehrig's disease Medicare advantage 27 Correct Answer: another name for Medicare Part C or a Replacement Plan; managed care coverage provided by private insurance companies approved by Medicare. Medicare beneficiary identifier Correct Answer: MBI a number replacing the HICN on the Medicare card Medicare Code Editor (MCE) Correct Answer: software that edits claims to detect incorrect billing data that is being submitted. Medicare Participating Physician Program Correct Answer: A program finding a physician to accept assignment for all services provided to Medicare patients for the following year MSP Correct Answer: Medicare Secondary Payer; laws that shifted costs from the Medicare program to other sources of payment; MSP information is gathered from each beneficiary to determine the proper coordination of benefits. MSN Correct Answer: A Medicare summary notice; a quarterly statement to the payee/beneficiary reflecting services received, charges submitted, charges allowed, 28 amount for which the beneficiary is responsible, and the amount that was paid to the provider or beneficiary Medigap Correct Answer: also known as Medicare supplemental insurance; health insurance sold by private insurance companies to fill in the "gaps" in coverage (like deductibles, coinsurance, and copayments) under the Original Medicare Plan; some Medigap policies also cover benefits that Medicare doesn't cover, like emergency healthcare while traveling outside the United States. Midnight census Correct Answer: The number of patients in the hospital at midnight; determined from the census count for the previous night minus any discharges plus any admissions, plus/minus any status changes Previous Midnight Census - Discharges + Admissions +/- Status Changes = Midnight Census Mini Miranda Correct Answer: a statement provided by a creditor to a debtor which says something like, "This is an attempt to collect a debt and any information obtained will be used for that purpose." 29 MOON Correct Answer: Medicare outpatient observation notice; a standardized notice developed to inform beneficiaries when they are an outpatient receiving observation services; established by the notice act MP Correct Answer: Malpractice insurance expense; one of three RVUs associated with the calculation of a payment under the MPPS MPPS Correct Answer: Medicare Prospective Payment System MS-DRG Correct Answer: Medicare Severity Diagnosis Related Group; A payment methodology system that combines patient age, diagnosis, discharge disposition, and procedures to determine a payment rate; the MS-DRG payment is the total payment for the case regardless of the actual charges unless an outlier is paid in certain cases with a very high charges MSA Correct Answer: Medical savings account; a type of Medicare advantage plan with two parts; a Medicare advantage high deductible plan and a medical savings account into which Medicare deposits money that people can use to pay healthcare costs 30 MSP questionnaire Correct Answer: a questionnaire completed on an ongoing basis to help determine if Medicare is primary or secondary; it asks about employment, accidents, and several other relevant subjects. MTF Correct Answer: Military Treatment Facility MUE Correct Answer: Medically Unlikely Edits; An automated pre-payment edit for the HCPCS/CPT codes for services rendered by provider to a single beneficiary on the same date of service; it helps to reduce errors due to clerical entries and incorrect coding based on the anatomic considerations MVPS Correct Answer: Medicare Volume Performance Standard; the element of the Resource Based Relative Value Scale (RBRVS) for the rates of increase in Medicare expenditures for physician services. National Correct Coding Initiative (NCCI) 31 Correct Answer: A Medicare initiative to promote correct coding methodologies and strive to illuminate a proper coding; it identifies mutually exclusive CPT and HCPCS codes or those that should not be billed together National Coverage Determination (NCD) Correct Answer: Medical review policies issued by CMS which identified specific medical items, services, treatment procedures, or technologies that can be covered and paid for by the Medicare program Non-Availability Statement Correct Answer: A requirement before any non-emergent inpatient services may be provided to a tri-care extra or standard eligible beneficiary by a non-MTF non-definitive LCD/NCD Correct Answer: A policy that provides potential coverage circumstances, but most likely does not provide specific diagnosis, science, symptoms or ICD 10 codes that will be covered or not covered Non-standard claim Correct Answer: a claim with extraneous attachments in lieu of data entered correctly in the claim form. Notice of observation treatment and implication for care eligibility (NOTICE) act 32 Correct Answer: an act requiring hospitals to use the MOON to inform patients who are hospitalized for more than 24 hours if they are in observation status. Notifier Correct Answer: An entity that issues ABNs NUBC Correct Answer: National Uniform Billing Committee; the entity that Covered the UB04 and 837I forms Observation Correct Answer: The level of care given a patient who occupies a bed but is an outpatient status; intended for monitoring of an acute condition, which may resolve or worsen; cannot be scheduled in advance and it was not intended for routine use, such as surgical recovery OCE Correct Answer: Outpatient code editor; edits to hospital outpatient services to detect pairs of codes that cannot be billed together and pairs the required modifiers Office Correct Answer: Any care provided in a practitioner's place of business. 33 outpatient Correct Answer: The level of patient care provided in one of many types of outpatient clinics Part A Correct Answer: The hospital insurance component of Medicare that covers medically necessary inpatient hospitalization, care in an SNF following a three day hospital stay, home health care, hospice care, and blood Part B Correct Answer: The medical insurance component of Medicare that pays for it medically necessary doctor services, outpatient hospital care, and some other medical services that Part A does not cover (such as the services of physical or occupational therapist and some home health care) Part C Correct Answer: A replacement for traditional Medicare also known as Medicare advantage or a replacement plan; managed care coverage provided by private insurance companies approved by Medicare Part D 34 Correct Answer: The component of Medicare that covers medication subject to an annual deductible; the list of coverage drugs is known as the formulary; drugs are placed into tiers and each tier can have a different cost Patient Care Partnership Correct Answer: A plain language brochure formally known as the patient's bill of rights it states expectations that patients and their families can have about how they will be treated in healthcare situations PCP Correct Answer: Primary care physician also known as the gate keeper PE Correct Answer: Practice expense one of the three RVUs associated with the calculation of a payment under the MPPS Per diem Correct Answer: Latin for "each day" a payment methodology in which providers are paid a predetermined amount for each day and in patient is in the facility, regardless of actual charges or cost incurred Percent of charges 35 Correct Answer: A payment methodology were a claim is paid at a predetermined percentage discount rate Percentage of occupancy Correct Answer: The ratio of actual patient days to the maximum patient days as determined by bed capacity; a low percentage of occupancy indicates an efficiency why percentage that is too high it will mean difficulty finding available beds, long hold times and ER etc. PHI Correct Answer: Protected health information; any data that can be used to individually or in combination to match patients with medical information Physician extender Correct Answer: Physician assistant nurse practitioner etc. a type of clinical and medical personnel authorized to make entries in the patient's medical record POA Correct Answer: Present on admission; a type of indicator that helps identify nonpayable complications, such as hospital acquired conditions PPACA 36 Correct Answer: Patient Protection and Affordable Care Act; also know it's simply the Affordable Care Act; together with the healthcare and education reconciliation act, part of the most significant regulatory overhaul of the United States healthcare system since the passage of Medicare and Medicaid in 1965 PPO Correct Answer: Preferred provider organization; one of the five types of Medicare advantage plans and which members can see any provider or a doctor that excepts Medicare and they don't need a referral to see a specialist PPS Correct Answer: Perspective payment system Precertification Correct Answer: the process of obtaining authorization from an insurance company review organization approving the medical necessity of services. Private fee-for-service plans Correct Answer: a type of Medicare Advantage Plan which allows members to go to any provider that accepts the plan's terms; the private company decides how much it will pay and how much members pay for services. PSDA 37 Correct Answer: Patient self determination act; legislation that ensures that patients understand their right to participate in decisions about their own health care; deals with advance directives QIO Correct Answer: Quality improvement organization; part of a CMS program to monitor and improve utilization and quality of care for Medicare beneficiary; QIOs review all written quality of service complaints submitted by Medicare beneficiaries or their designated representatives RA Correct Answer: Remittance advice; a statement sent by health insurance company to cover individuals explaining what medical treatment/services were paid for on their behalf; similar to an EOB, but an RA should have a check attached or a voucher for an electronic payment which was me directly to the providers bank Recurring Correct Answer: Also known as a Series; a level of patient care for outpatients who will be coming regularly for repetitive types of treatment, such as physical therapy or chemotherapy Reduction 38 Correct Answer: A decrease in the frequency or duration of care; one of the triggering events for an ABN Resource-Based Relative Value Scale (RBRVS) Correct Answer: A payment methodology comprised of three major elements: fee schedule for physician services based on the RVU, MVPS, and limiting charge Resource Utilization Groups (RUGs) Correct Answer: A system to determine the payment rate for most skilled nursing care, the provider completes the MDS, the MDS determines that RUG and hence the payment; the patient is reevaluate at intervals during his or her stay and the RUG rate may be changed respite Correct Answer: Short term, temporary custodial care about allows a family member or other and paid caregiver to get some relief from caring for a physically frail or dependent person at home RTP Correct Answer: Returned to provider; the many processes utilized for notifying provider that a claim cannot be processed and must be corrected or resubmitted RVU 39 Correct Answer: relative value unit; the basis for the fee schedule for payment of physician services that is one of the elements of the Resource Based Relative Value Scale (RBRVS). Self insurance Correct Answer: a company that puts premium payments into a fund to cover services and pays a third party to administer benefits from the fund instead of purchasing group insurance. Self-pay Correct Answer: the common term for patients who have no insurance. Skip Correct Answer: a debtor who cannot be located by a creditor; there are three types: intentional; unintentional, and false. SNF Correct Answer: Skilled nursing facility; a separate wing of the hospital a nursing home are you freestanding facility to qualify for SNF coverage Medicare requires person to have been a hospital impatient for at least three consecutive days not including the day of discharge SNF PPS 40 Correct Answer: Skilled nursing facility perspective payment system; the payment methodology for which skilled nursing care; the provider complete the MDS which determines the RUG and hence the payment Special Needs Plan Correct Answer: A type of Medicare advantage plan which limits all or most of the membership to people and some long-term care facilities and who are eligible for Medicare and Medicaid Spell of an illness Correct Answer: Also known as the benefit.; A period of time that begins with a beneficiary enters the hospital and in 60 days after the discharge from the hospital or from the SNF Statute of limitations Correct Answer: Amount of time in which a claim must be collected before it is not paid or satisfied no legal proceedings can be initiated after the statute of limitation expires Superbill Correct Answer: Also known as an encounter form; the pre-printed sheet use to record related to a patient encounter Telephone Consumer Protection Act (TCPA) 41 Correct Answer: Legislation that restricts telephone solicitations and the use of automated telephone equipment in other words telemarketing Termination Correct Answer: A discontinuation in the services being provided; one of the triggering events for an ABN Title XVIII Correct Answer: Medicare Title XIX Correct Answer: Medicaid Tort liability Correct Answer: a liability for an injury or wrongdoing by one person to another resulting from a breach of legal duty. TPA Correct Answer: Third-party administrator TRICARE Correct Answer: Healthcare coverage for an active duty service members their spouses dependence and retirees unless they are eligible for Medicare 42 TRICARE for Life Correct Answer: a healthcare program for qualified service retirees that acts as a supplement to Medicare. Triggering event Correct Answer: an event that occurs during initiation, reduction, or termination of a course of treatment that triggers the need for an ABN. Truth in Lending Act Correct Answer: Another name for Regulation Z; it requires disclosure of information before credit is extended UB-04 Correct Answer: The hardcopy version of the hospital claim form also known as CMS 1450 UCR Correct Answer: Usual, customary, and reasonable; a payment methodology used by many third payers which where physician charge data accumulated overtime is ranked from lowest to highest and a specific point is the basis for payment (for example the 75th percentile) 43 Unintentional Correct Answer: A type of skip in which someone moves are changes residence and failed to notify creditors; a forwarding address is normally available unprocessable Correct Answer: a claim that is considered incomplete or invalid due to missing claim form data elements. Usual, customary, and reasonable Correct Answer: A payment methodology used by many third-party payers where physician charge data accumulated overtime is ranked from lowest to highest and a specific point Utilization Review (UR) Correct Answer: Also known as case management; an area that performs critical task during registration and patients stay VA Correct Answer: US department of Veterans Affairs Work RVU Correct Answer: Work required; one of three RVUs associated with the calculation of a payment under the MPPS. 44 Workers compensation Correct Answer: A plan that covers injuries sustained by a worker in the course of performing his or her job duties What is the primary duty the front office personnel Correct Answer: To act as a liaison between the physician and the patient, from billing to collections to patient care Precertification/Preauthorization Correct Answer: authorization provided by an insurance company review organization approving the medical necessity of services How long do you keep ABN? Correct Answer: 5 years from discharge or the completion of care, Provided that there are no other applicable requirements which fall under state-specific law National Drug Code Correct Answer: NDC; A unique, 11 digit, three segment numeric identifier that is assigned to each medication listed under the FDA 1.) The first segment identifies the labeler, which is the company that manufactures or distributes the drug 2.) The second segment identifies the type of product 45 3.) The third segment identifies the size and type of the package Condition code Correct Answer: A two-digit code that clarifies an event or condition related to the bill that may affect payer processing 04-informational only 08-beneficiary would not provide information concerning other insurance coverage 21-Billing for denial notice Occurrence code Correct Answer: A two digit code and a date that together clarify a significant event or condition related to a claim, such as: 11-onset of symptoms/illness 24-Date insurance denied 32-Date that an ABN, form CMS-R-131, was given to a beneficiary Occurrence span code Correct Answer: A two digit code followed by two dates that identify a span of time relevant to claim processing, such as: 70-non-utilization days: PPS inlier (free days) Stay for which the beneficiary has exhausted all regular day/coinsurance days, but which is covered on the cost report 46 74-Non-covered level of care: from/through dates of a period at a non-covered level of care or leave of absence in an otherwise covered stay 76-Patient liability: from/through dates of a period of non-covered care for which the hospitals/SNF is permitted to put a charge the Medicare beneficiary Type of bill (TOB) Correct Answer: A three-digit (excluding the leading zero) code and field locator for that describes the type of bill the hospital is submitting to the payer Type of bill - digit one Correct Answer: The type of facility Type of bill - digit two Correct Answer: The bill classification Type of bill - digit three Correct Answer: The Frequency The 5 points of collection control for facility setting Correct Answer: 1.) preadmission 2.) admission 3.) in-house 4.) at discharge 47 5.) after discharge The 5 points of collection control for professional setting Correct Answer: 1.) preservice 2.) time of service 3.) in-house 4.) at checkout 5.) post service What is the current Part A beneficiary obligation for 1-60 days of a hospital stay? Correct Answer: $1556 Per spell of illness What is the current Part A beneficiary obligation for days 91 through 150 of a hospital stay? Correct Answer: $778 per day (1/2 or 50% of current year and patient deductible) What is the current beneficiary obligation for days 1-20 of SNF care? Correct Answer: $0, No deductible or coinsurance What is the current Part A beneficiary obligation for 61 to 90 days of a hospital stay? Correct Answer: $389 per day (1/4 or 25% of current ear and patient deductible) What is the current Part A beneficiary obligation for days 21 through 100 of SNF care? 48 Correct Answer: $194.40 per day (1/8 of current year and patient deductible) What is the current Part A beneficiary obligation for days 1-20 of home health care? Correct Answer: $0 no deductible or coinsurance What is the current Part A beneficiary obligation for DME? Correct Answer: 20% of Medicare approved amount What is the current Part A beneficiary obligation for hospice care? Correct Answer: $0 (no deductible or coinsurance) What is the current Part B beneficiary obligation for Doctor services (except for routine physical exams)? Correct Answer: $233 per year, then 20% of Medicare approved amount What is the current Part A beneficiary obligation for blood? Correct Answer: First 3 pints per year. Current blood deductible (unless the patient or someone else donates to replace the blood received) What is the current Part B beneficiary obligation for outpatient mental health care? Correct Answer: 20% of Medicare approved amount 49 How often can a qualified Medicare beneficiary receive a screening test for diabetes, if diagnosed with pre-diabetes? Correct Answer: Two per year How often can a qualified Medicare beneficiary receive a screening mammogram, after the baseline screening? Correct Answer: Once every 12 months How often can a qualified Medicare beneficiary receive a PSA test? Correct Answer: Once every 12 months How often can a qualified Medicare beneficiary receive a flu shot? Correct Answer: Once a year, per flu season How often can a qualified for Medicare beneficiary receive a pneumonia shot? Correct Answer: One shot can be followed by a second, different shot one year later How often can a qualified Medicare beneficiary receive smoking and tobacco use cessation counseling? Correct Answer: Two cessation attempts per year; each attempt includes up to four sessions How often can a qualified Medicare beneficiary receive screening for depression? 50 Correct Answer: Annually for all beneficiaries What is the frequency of coverage for intensive behavioral therapy for obesity? Correct Answer: One visit every week for month 1; one visit every other week for months 2-6; and one visit every month for months 7-12 What are the seven components of an E&M code? Correct Answer: 1.) History 2.) examination 3.) medical decision-making 4.) counseling 5.) coordination of care 6.) nature of presenting problem 7.) time spent TPO Correct Answer: Treatment,Payment, and Healthcare Operations1 CRCS CERTIFICATION EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+ CMS Correct Answer: Centers for Medicare and Medicaid Services and also one of the HHS operating divisions OIG Correct Answer: Office of Inspector General in DHHS. Monitors compliance with reimbursement laws & regulations Title XVIII Correct Answer: Medicare Title XIX Correct Answer: Medicaid HIPAA Correct Answer: Health Insurance Portability and Accountability Act HHS 2 Correct Answer: Department of Health & Human Services. And has 11 operating divisions NIH Correct Answer: National Institutes of Health; one of the HHS Operating Divisions. FDA Correct Answer: Food and Drug Administration - one of the HHS operating divisions CDC Correct Answer: Center for Disease Control and prevention; one of the HHS operating divisions ATSDR Correct Answer: Agency for Toxic Substances and Disease Registry; one of the DHHS Operating Divisions. IHS Correct Answer: Indian Health Service; one of the DHHS Operating Divisions. HRSA Correct Answer: Health Resources and Services Administration; one of the HHS Operating Divisions. 3 AHRQ Correct Answer: Agency for Healthcare Research and Quality; one of the HHS operating divisions QIO Correct Answer: Quality Improvement Organization; part of a CMS program to monitor and improve utilization and quality of care for Medicare beneficiaries. ACF Correct Answer: Administration for Children and Families; one of the DHHS Operating Divisions. ACL Correct Answer: Administration for Community Living; one of the DHHS Operating Divisions. AHA Correct Answer: American Hospital Association Patient Bill of Rights Correct Answer: Adopted in 1970s, states expectations that patients and their families can have about how they will be treated in healthcare situations 4 Patient Care Partnership Correct Answer: Replacing the AHA's Patients' Bill of Rights, this plain language brochure informs patients about what they should expect during their hospital stay with regard to their rights and responsibilities. 1-day payment window rule Correct Answer: a Medicare requirement similar to the 3-day payment window rule that applies to inpatient psychiatric hospitals, inpatient rehabilitation facilities, long term care facilities, and children's and cancer hospital. 3-day payment window rule Correct Answer: a Medicare requirement that all diagnostic and clinically related nondiagnostic outpatient services provided within three days of an inpatient admission must be combined to the inpatient claim when they are provided by an entity wholly owned or operated by the inpatient hospital (or by another entity under arrangements with the admitting hospital) 837I Correct Answer: the dataset that is utilized to electronically submit hospital claims to the payer. 837P 5 Correct Answer: the billing form used to electronically submit physician and professional service claims to the payer ABN Correct Answer: Advanced Beneficiary Notice of non-coverage; 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 Correct Answer: Incidents or practices of healthcare workers that although not unusually considered fraudulent are and inconsistent with accepted sound practices Accounts receivable (AR) days outstanding Correct Answer: another name for Average Days of Revenue in Accounts Receivable (ADRR); 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. Actual or expressed consent Correct Answer: written or oral agreement by the patient to the treatment outlined. ADC 6 Correct Answer: Average daily census; the average number of inpatient maintain in the hospital each day for a specific period of time Total Number of Patient days / Number of Days = ADC ADRR Correct 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. ALOS Correct Answer: average length of stay; a metric calculated by dividing the total number of patient days by the number of discharges. Total number of Patient Days/Number of Discharges = ALOS APC Correct Answer: Ambulatory payment classification; a payment methodology in which services paid under the perspective payment system are classified into groups that are similar clinically and in terms of resources they require; a payment rate is established for each APC 7 APR Correct Answer: Annual Percentage Rate; One of the elements of disclosure required by the truth in lending act Assignment of benefits Correct Answer: Written authorization signed by the policyholder to an insurance company to pay benefits directly to the provider when assignment is not excepted the payment will be sent to the patient and the provider will have to collect it ATB Correct Answer: aged trial balance; a resource for internal collection efforts. Average Daily Census (ADC) Correct Answer: The average number of inpatients maintained in the hospital each day for a specific period of time Average daily revenue Correct Answer: The average amount of revenue or charges generated each day for a specific period of time Average Days of Revenue in Accounts Receivable Correct Answer: also known as Accounts Receivable (AR) Days Outstanding; an estimate, using average current revenues, of the days required to turn over the 8 accounts receivable under normal operating conditions; in simple terms, this is an estimate of the time needed to collect the accounts receivable. bad debt Correct Answer: An uncollectible account resulting from an extension of credit beneficiary Correct Answer: A person who has health care insurance through Medicare Birthday rule Correct Answer: A rule to determine coordination for benefits for a child covered by both parents dictates that the parent with the first birthday in the calendar year it 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 (BLBA) Correct Answer: Legislation that established the federal black lung program for individuals who have been diagnosed with pneumoconiosis or black lung disease Capitation Correct 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 receive for that period. No matter the actual charges 9 case management Correct Answer: Also known as utilization review (UR) an area that performs critical tasks during registration and patients stay Chapter 7 Bankruptcy Correct 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 debtors assets are auctioned to satisfy creditor claims; about 70% of all bankruptcy claims are filed under this chapter Chapter 11 Bankruptcy Correct Answer: A type of bankruptcy frequently referred to as "re-organization"; it gives a distressed business a reprieve from creditor claims while it continues to function and works out a repayment plan Chapter 12 Bankruptcy Correct Answer: A type of bankruptcy for a family farmer with "regular annual income" Chapter 13 Bankruptcy Correct 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 10 supervision and protection, may propose and carry out repayment plan under which creditors are paid over an extended period of time Charge master or CDM (charge description master) Correct Answer: An electronic file that resides in the providers information system and that contains charges that can be posted to a patient account Charity Care Correct Answer: Service provided that is never expected to result in cash flow; it results from the providers policy to provide healthcare services free of charge or at a reduced cost to individuals who meet certain financial criteria CHIP Correct Answer: Children's Health Insurance Program also known as title XXI for children whose families failed to qualify for Medicaid but cannot afford to purchase private insurance; jointly financed by the federal and state governments in administered by the states Clinical Laboratory Improvement Amendments (CLIA) Correct Answer: Legislation requiring all clinical laboratory services furnished to Medicare beneficiaries to be performed by a provider who has a CLIA certificate CMP 11 Correct Answer: Civil Monetary Penalty CMS-1450 Correct Answer: Another name for the UB04 for uniform bill form CMS-1500 Correct Answer: The paper billing form used to submit physician and professional service claims to Medicare CO Correct Answer: Compliance officer; one of the OIG seven elements of compliance plan COB Correct Answer: coordination of benefits Commercial Insurance Correct Answer: health insurance that covers individuals, usually as an employment benefit but also purchased as an individual policy. Common Working File (CWF) Correct Answer: a CMS file that contains Medicare patient eligibility and utilization data Conditional payment 12 Correct Answer: A payment made when another pair is responsible, but the claim is not expected to be paid properly (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 pair Courtesy discharge Correct 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 CPT Correct Answer: Current procedural terminology; a system of descriptive terms and five digit numeric codes that are used primarily to identify medical services and procedures finished by physicians and other healthcare professionals Critical Access Hospital (CAH) Correct Answer: A small hospital that serves a rural community; maintains no more than 25 inpatient beds that may be used for swing bed services; may operate A distinct part rehabilitation/psychiatric unit each with up to 10 beds; has an ALOS of 96 hours or less per patient for acute care is located more than a 35 mile drive from any hospital or CAH in any area with mountainous terrain or only secondary roads; it furnishes 24/7 care emergency care 13 Custodial Care Correct Answer: help with bathing, dressing, toileting, and eating. data mailer Correct 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. definitive LCD/NCD Correct Answer: a policy that discusses and lists specific diagnosis codes, ICD procedure codes, and possibly signs and symptoms to support the need for the item or service being given. Discharge of debtor Correct Answer: a potential outcome of bankruptcy that releases the guarantor/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. dismissal Correct Answer: A court ruling whereby a bankruptcy is rejected by the court; the most common reason for a dismissal is a failure of the debtor to follow through on the final process and on payment to the attorney and failure to provide requested 14 documentation; upon dismissal of bankruptcy, a creditor can bill the debtor directly, refer to the account to collections agency and pursue litigation DME Correct Answer: durable medical equipment, such as wheelchairs, hospital beds, oxygen, and walkers. DMEPOS Correct Answer: Durable medical equipment, prosthetics, orthotics, and supplies DNR order Correct Answer: Do not resuscitate order; a document stating that the patient does not wish to have CPR or similar interventions performed in the event of a medical emergency DSMT Correct Answer: Diabetes Self-Management Training; a Medicare Part B covered preventive service. Dual eligible Correct Answer: An individual who is entitled to Medicare part A/part B and also eligible for some form of Medicaid benefit 15 ECOA Correct Answer: Equal Credit Opportunity Act; a law that prohibits credit discrimination on the basis of race, color, religion, national origin, sex, marital status, age, or because someone receives public assistance. EGHP Correct Answer: Employer Group Health Plan Emancipation Correct Answer: The process by which a minor is free 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) EMTALA (Emergency Medical Treatment and Active Labor Act) Correct Answer: EMTALA; also known as the federal anti-dumping statute; legislation enacted in response to concerns that hospitals refusing to treat patients without insurance and even transferring them to other facilities and leaving them there, sometimes without notifying the receiving a Facility ER or ED Correct Answer: emergency room or emergency department A level of patient care; patients in the ER are outpatients 16 EOB (explanation of benefits) Correct Answer: Explanation of benefits; a statement sent by a health insurance company to covered individuals explaining what medical treatment/services were paid for on their behalf; similar to an RA; it may or may not have a check attached for payment of services Evaluation and management Correct Answer: (E&M) both the process of and the charge for examining a patient and formulating a treatment plan. Fair Credit Billing Act Correct Answer: Legislation that protects consumers from inaccurate or unfair practices by issuers open ended credit and requires creditors to inform debtors of their rights and of the responsibilities of the creditor Fair Credit Reporting Act Correct Answer: Legislation that defines what information from "consumer reports" can be used by whom and when; it provides the maximum protection of a consumers right to privacy and confidentiality of credit reports Fair Debt Collection Practices Act 17 Correct Answer: Legislation enacted as the result of evidence that debt collectors were using abusive, deceptive, and unfair collection practices; and impose a strict limitation and prohibitions on debt collection practices False Correct Answer: A type of skip generally caused by clerical error at the time of registration, such as transpose numbers in the street address, and incorrect ZIP Code, or incomplete information False Claims Act (FCA) Correct Answer: Legislation that prohibits making a false record or statement to get false/fraudulent claim paid by the government, submission of false/fraudulent claims, and conspiring To have false fraudulent claims paid by the government fee-for-service Correct Answer: The oldest method of payment, in which providers are paid for each medical service rendered to a patient fee schedule Correct Answer: a payment methodology for some outpatient services; the schedule lists CPT and HCPCS codes and what Medicare allows for each, before deductible and coinsurance is applied 18 GAAP Correct Answer: Generally accepted accounting principles; a common set of accounting principles, standards, and procedures that companies must follow when they compile their financial statements gate keeper Correct Answer: The primary care physician or PCP HCPCS Correct Answer: Health care common procedure coding system; a mandated transaction code set for outpatient procedures Health Care Power of Attorney (HCPA) Correct Answer: Also known as durable power of attorney for healthcare; a document that designate someone else to make decisions on the patients behalf if he or she is unable to do so HHS Correct Answer: US Department of health and human services; the governments principle agency for protecting the health of all Americans and providing essential human services HMO 19 Correct Answer: Health maintenance organization; one of five types of Medicare advantage plans in which members miss generally get healthcare providers in the plans network Home health Correct Answer: Limited part-time or intermittent skilled nursing care and home health aide services, physical therapy, occupational therapy, speech-language therapy, medical social services, DME, medical supplies, and other services. Hospice Correct Answer: Coordinated, palliative care provided to terminally ill patients and their families by nonprofit organizations Hospital issued a notice of non-coverage (HINN) Correct Answer: A liability notice similar to an ABN; hospitals give HINNs fee for service inpatient hospital beneficiaries who are due to receive specific diagnostic or therapeutic procedures that are separate from treatment covered/paid /bundled into the inpatient stay HSA Correct Answer: Health savings account; a bank account maintained by a patient to pay medical expenses not covered by insurance; fines and interest in the HSA are not 20 taxed; to have an HSA, the subscriber must be enrolled in a specific, high deductible health plan I-Bill Correct Answer: an itemized statement ICD Correct Answer: International classification of diseases; a mandated transaction codes that used for diagnosis and inpatient procedures ICD-10 Correct Answer: The current version of the international classification of diseases used in the United States IEQ Correct Answer: Initial Enrollment Questionnaire; a questionnaire mailed about three months before patients become entitled to Medicare; it asks about any other healthcare coverage that may be primary to Medicare Implied consent by law Correct Answer: Consent that occurs in a situation where the patient is unconscious and is taken to the emergency room; the law allows treating the patient 21 Implied consent in fact Correct Answer: consent by silence; the patient implies consent to