AAHAM CERTIFIED REVENUE CYCLE PROFESSIONAL (CRCP) TERMS
- 2024 (KD) QUESTIONS AND ANSWERS
3-Day Rule - CORRECT 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 - CORRECT ANSWER✅✅✅the American National Standards Institute transaction for an
institutional claim; as a result of HIPAA, it is replacing the electronic UB-04.
837P - CORRECT 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 - CORRECT ANSWER✅✅✅quarterly Medicare Credit Balance Report
CMS 1450 - CORRECT ANSWER✅✅✅another name for the UB-04 Uniform Bill form.
CMS 1500 - CORRECT ANSWER✅✅✅the billing form used to submit physician and professional
service claims to Medicare.
ABN - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT ANSWER✅✅✅Average Daily Census; the average number of inpatients maintained
in the hospital each day for a specific period of time.
ALOS - CORRECT ANSWER✅✅✅Average length of Stay; a metric calculated by dividing the total
number of patient days by the number of discharges.
Ambulatory Payment Classification - CORRECT ANSWER✅✅✅a payment methodology that places
outpatient services into groups based on similar procedures and resource use.
Americans with Disabilities Act - CORRECT 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 - CORRECT ANSWER✅✅✅AR balance less the average deduction from
revenue, based on the historical deduction from revenue rate.
Anti-Kickback Statute - CORRECT ANSWER✅✅✅a law that prohibits offering free or discounted
services to a physician associated with, or who refers patients to, another healthcare facility.
APC - CORRECT 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 - CORRECT ANSWER✅✅✅accounts receivable.
,AR Days - CORRECT ANSWER✅✅✅Days a measure of how long, on average, it takes to collect
revenue from the date of discharge.
Asset - CORRECT ANSWER✅✅✅control procedures to protect assets from theft. Assets, those things
a business owns that have a value.
Assignment of benefits - CORRECT 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 - CORRECT 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 - CORRECT ANSWER✅✅✅the average number of inpatients maintained in the
hospital each day for a specific period of time.
Average length of stay - CORRECT ANSWER✅✅✅the total number of patient days divided by the
number of discharges.
Bad debt - CORRECT ANSWER✅✅✅a deduction from revenue when an account is determined to be
uncollectible.
Balance sheet - CORRECT ANSWER✅✅✅a financial statement that is a snapshot in time of the
business.
Bankruptcy - CORRECT 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 - CORRECT ANSWER✅✅✅the number of days a bill sits before a claim drops
, CAH - CORRECT 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 - CORRECT ANSWER✅✅✅the kind of asset that cannot be-easily turned into cash, such as
land, buildings, and large equipment.
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 receives for that period, no matter the actual charges.
Cash flow statement - CORRECT ANSWER✅✅✅one of four common financial statements; the others
are the balance sheet, income statement, and changes in fund balances statement.
Cash - CORRECT 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 - CORRECT ANSWER✅✅✅one of the five types of
CLIA certificates; each is valid for two years.
Certificate of Accreditation - CORRECT ANSWER✅✅✅one of the five types of CUA certificates; each
is valid for two years.
Certificate of Compliance - CORRECT ANSWER✅✅✅one of the five types of CLIA certificates; each is
valid for two years.
Certificate of Registration - CORRECT ANSWER✅✅✅one of the five types of CLIA certificates;each is
valid for two years.
Certificate of Waiver - CORRECT ANSWER✅✅✅one of the five types of CUA certificates; each is valid
for two years.
- 2024 (KD) QUESTIONS AND ANSWERS
3-Day Rule - CORRECT 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 - CORRECT ANSWER✅✅✅the American National Standards Institute transaction for an
institutional claim; as a result of HIPAA, it is replacing the electronic UB-04.
837P - CORRECT 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 - CORRECT ANSWER✅✅✅quarterly Medicare Credit Balance Report
CMS 1450 - CORRECT ANSWER✅✅✅another name for the UB-04 Uniform Bill form.
CMS 1500 - CORRECT ANSWER✅✅✅the billing form used to submit physician and professional
service claims to Medicare.
ABN - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT ANSWER✅✅✅Average Daily Census; the average number of inpatients maintained
in the hospital each day for a specific period of time.
ALOS - CORRECT ANSWER✅✅✅Average length of Stay; a metric calculated by dividing the total
number of patient days by the number of discharges.
Ambulatory Payment Classification - CORRECT ANSWER✅✅✅a payment methodology that places
outpatient services into groups based on similar procedures and resource use.
Americans with Disabilities Act - CORRECT 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 - CORRECT ANSWER✅✅✅AR balance less the average deduction from
revenue, based on the historical deduction from revenue rate.
Anti-Kickback Statute - CORRECT ANSWER✅✅✅a law that prohibits offering free or discounted
services to a physician associated with, or who refers patients to, another healthcare facility.
APC - CORRECT 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 - CORRECT ANSWER✅✅✅accounts receivable.
,AR Days - CORRECT ANSWER✅✅✅Days a measure of how long, on average, it takes to collect
revenue from the date of discharge.
Asset - CORRECT ANSWER✅✅✅control procedures to protect assets from theft. Assets, those things
a business owns that have a value.
Assignment of benefits - CORRECT 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 - CORRECT 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 - CORRECT ANSWER✅✅✅the average number of inpatients maintained in the
hospital each day for a specific period of time.
Average length of stay - CORRECT ANSWER✅✅✅the total number of patient days divided by the
number of discharges.
Bad debt - CORRECT ANSWER✅✅✅a deduction from revenue when an account is determined to be
uncollectible.
Balance sheet - CORRECT ANSWER✅✅✅a financial statement that is a snapshot in time of the
business.
Bankruptcy - CORRECT 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 - CORRECT ANSWER✅✅✅the number of days a bill sits before a claim drops
, CAH - CORRECT 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 - CORRECT ANSWER✅✅✅the kind of asset that cannot be-easily turned into cash, such as
land, buildings, and large equipment.
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 receives for that period, no matter the actual charges.
Cash flow statement - CORRECT ANSWER✅✅✅one of four common financial statements; the others
are the balance sheet, income statement, and changes in fund balances statement.
Cash - CORRECT 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 - CORRECT ANSWER✅✅✅one of the five types of
CLIA certificates; each is valid for two years.
Certificate of Accreditation - CORRECT ANSWER✅✅✅one of the five types of CUA certificates; each
is valid for two years.
Certificate of Compliance - CORRECT ANSWER✅✅✅one of the five types of CLIA certificates; each is
valid for two years.
Certificate of Registration - CORRECT ANSWER✅✅✅one of the five types of CLIA certificates;each is
valid for two years.
Certificate of Waiver - CORRECT ANSWER✅✅✅one of the five types of CUA certificates; each is valid
for two years.
