Aaham Crce 2024 Exam Study Guide With Complete Solutions

AAHAM CRCE 2024 EXAM STUDY GUIDE WITH COMPLETE SOLUTIONS 1-day payment window rule -Answer-a Medicare requirement similar to the day payment window rule that applies to inpatient poychiatric hosp tals, inpatient rehabilitation facilities, long term care facilities, and chil dren's and cancer hospital. 3-day payment window rule -Answer-a Medicare requirement that all diagnostic and clinically related non-diagnostic outpatient services provided with in three days of an inpatient admission must combined the inpa- tient claim when they are provided by an entity wholly owned or oper ated by the inpatient hospital (or by another entity under arrangements with the admitting hospital). 8371 -Answer-the dataset that is utilized to electronically submit hospital claims to the payer. 837P -Answer-the HIPAA standard transaction that replaces the CMS-1500 and is required of almost all physicians. 838 report -Answer-a mandatory quarterly credit balance report used to monitor identification and recovery of credit balances owed to Medicare. Advance Beneficiary Notice ABN -Answer-Document that acknowledges patient responsibility for payment if Medicare denies the claim. Agents -Answer-individuals to help consumers and small businesses complete the application process and enroll in health coverage through the Marketplace Abuse -Answer-incidents or practices of providers Physicians or suppliers of services that although not usually considered fraudulent are inconsistent with accepted sound medical business or fiscal practices directly or indirectly resulting in unnecessary costs to the insurer and improper reimbursement for services that fail to meet professionally recognized standards of care or that are medically unnecessary accrual method -Answer-a method of accounting that generally recognizes income in the period earned and recognizes deductions in the period that liabilities are incurred. ACF -Answer-Administration for Children and Families one of HHS operating divisions ACL -Answer-Administration for Community Living; one of the HHS Operating Divisions. Americans with Disabilities Act, ADA -Answer-Comprehensive legislation that is designed to protect individuals with disabilities against discrimination. Advanced alternative payment models, APMs -Answer-one of two ways conditions can choose to participate in the quality payment program, clinicians may earn a Medicare incentive payment for sufficiently participating in an innovative payment model administrative law judge, ALJ -Answer-the third level of both the Medicare and RAC appeals process Advance beneficiary notice -Answer-Document that acknowledges patient responsibility for payment if Medicare denies the claim. agents -Answer-individuals who help consumers and small businesses complete the application process and enroll in health care coverage through the marketplace. They are able to make recommendations about coverage and may only sell plans from specific health insurance companies AHA -Answer-American Hospital Association AHRQ -Answer-Agency for Healthcare Research and Quality; one of the HHS Operating Divisions ANSI -Answer-American National Standards Institute Anti-Kickback Statute -Answer-Prohibits offering, paying, soliciting or receiving anything of value to induce or reward referrals or generate federal healthcare program business. ambulatory payment classification, APC -Answer-a payment methodology used for Medicare's OPPS which places services into groups based on similar clinical characteristics and similar cost. Each a PC has a weighted value that bundles payment for Associated services AR Days -Answer-a measure of how long, on average, it takes to collect revenue from the date of discharge. Gross AR days have not had any allowances deducted, while net AR days have had some or many deductions Asset control -Answer-procedures to protect assets from theft assignment of benefits -Answer-patient's written authorization giving the insurance company the right to pay the physician directly for billed charges ATSDR -Answer-Agency for Toxic Substances and Disease Registry; one of the HHS Operating Divisions. Automated -Answer-a type of RAC review where the RAC merely identifies a potential issue and uses its database to find improper payments. The provider is then given notification of denied claims average daily census, ADC -Answer-the total number of patient days in a given time Divided by the number of days in that period