AAHAM CRCS EXAMS SCRIPT 2025/2026 QUESTIONS WITH
ANSWERS RATED A+
✔✔birthday rule - ✔✔a rule to determine coordination for benefits for a child
covered by both parents; it dictates that the parent with the first
birthday in the calendar year 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 - ✔✔legislation which provides for medical
treatment for coal miners totally disabled from black lung disease.
✔✔Bressers - ✔✔a cross-reference directory used in skip tracing.
✔✔brokers - ✔✔individuals who help consumers and small businesses complete
the application process and enroll in healthcare coverage through the Marketplace; they
are able to make recommendations about coverage and may only sell plans from
specific health insurance companies.
✔✔CAH - ✔✔Critical Access Hospital
✔✔Call centers - ✔✔an option for consumers to ask questions about health
coverage options and obtain assistance with the Marketplace application
process.
✔✔capitation - ✔✔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.
✔✔Case Management - ✔✔also known as Utilization Review (UR); an area that
performs critical tasks during registration and a patient's stay, such as reducing
unnecessary admissions; managing the approved length of stay; ensuring an
appropriate level of care for the patient's condition; serving as liaison with the primary
and specialty physicians; serving as liaison with the insurance carrier; obtaining
approvals, when clinically necessary, for pre-certification/re-certification; advising the
patient of discharge; and assisting with appeals for denials, when applicable.
✔✔CDC - ✔✔Centers for Disease Control and Prevention; one of the DHHS
Operating Divisions.
✔✔CDM - ✔✔charge description master; the chargemaster or master pricing list that
includes services, supplies, devices, and medication charges for inpatient or outpatient
services by a healthcare facility.
✔✔CERT - ✔✔Comprehensive Error Rate Testing.
,✔✔Certified application counselors - ✔✔individuals (staff members or volunteers) who
fulfill some of the same roles as Navigators and non-Navigators; they are not
responsible for outreach and education but they do provide free information to
consumers about insurance programs, they assist them in applying for coverage, and
they help to facilitate the enrollment in health coverage.
✔✔CHAMPUS - ✔✔Civilian Health and Medical Programs of the Uniformed
Services; the programs replaced by Tricare to cover healthcare for active duty and
retired members of the uniformed services, their families, and survivors.
✔✔Chapter 7 - ✔✔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 creditor claims; about
70% of all bankruptcy claims are filed under Chapter 7.
✔✔Chapter 11 - ✔✔a type of bankruptcy frequently referred to as a "reorganization"; it
gives a distressed business a reprieve from creditor claims while it continues to function
and works out a repayment plan.
✔✔Chapter 12 - ✔✔a type of bankruptcy for a family farmer with "regular annual
income."
✔✔Chapter 13 - ✔✔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 supervision and protection, may propose and carry out a repayment plan
under which creditors are paid over an extended period of time.
✔✔chargemaster - ✔✔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.
✔✔charity care - ✔✔service provided that is never expected to result in cash
✔✔SCHIP - ✔✔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 governments, and
administered by the states.
✔✔CLIA - ✔✔the Clinical Laboratory Improvement Amendment of 1988;
legislation requiring all clinical laboratory services furnished to
Medicare beneficiaries to be performed by a provider who has a CLIA certificate.
✔✔Clinical Laboratory Improvement Amendment (CLIA) of 1988 - ✔✔legislation
requiring all clinical laboratory services furnished to
, Medicare beneficiaries to be performed by a provider who has a CLIA
certificate.
✔✔CMP - ✔✔civil monetary penalty.
✔✔CMS - ✔✔Centers for Medicare and Medicaid Services; one of the DHHS
Operating Divisions.
✔✔CMS 1450 - ✔✔another name for the UB-04 uniform bill form.
✔✔CMS 1500 - ✔✔the billing form used to submit physician and professional
service claims to Medicare.
✔✔CO - ✔✔compliance officer.
✔✔COB - ✔✔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.
✔✔Common Working File - ✔✔a CMS file that contains Medicare patient
eligibility and utilization data.
✔✔conditional payment - ✔✔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.
✔✔Consumer assistance programs - ✔✔a resource to help to address consumers'
problems or questions about health coverage.
✔✔Consumer Credit Protection Act - ✔✔the first general federal consumer protection
legislation; its provisions include the Truth in Lending Act, the Fair Credit Billing Act, the
Fair Credit Reporting Act, and the Fair Debt Collection Practices Act.
✔✔coordination of benefits contractor - ✔✔a contracted entity that assists with the
collection, management, and reporting of other health coverage; COB contractors do
not process claims for the provider; they gather and disseminate coordination of
benefits information to ensure that Medicare is not making primary payment for a
service in error.
✔✔courtesy discharge - ✔✔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.
ANSWERS RATED A+
✔✔birthday rule - ✔✔a rule to determine coordination for benefits for a child
covered by both parents; it dictates that the parent with the first
birthday in the calendar year 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 - ✔✔legislation which provides for medical
treatment for coal miners totally disabled from black lung disease.
✔✔Bressers - ✔✔a cross-reference directory used in skip tracing.
✔✔brokers - ✔✔individuals who help consumers and small businesses complete
the application process and enroll in healthcare coverage through the Marketplace; they
are able to make recommendations about coverage and may only sell plans from
specific health insurance companies.
✔✔CAH - ✔✔Critical Access Hospital
✔✔Call centers - ✔✔an option for consumers to ask questions about health
coverage options and obtain assistance with the Marketplace application
process.
✔✔capitation - ✔✔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.
✔✔Case Management - ✔✔also known as Utilization Review (UR); an area that
performs critical tasks during registration and a patient's stay, such as reducing
unnecessary admissions; managing the approved length of stay; ensuring an
appropriate level of care for the patient's condition; serving as liaison with the primary
and specialty physicians; serving as liaison with the insurance carrier; obtaining
approvals, when clinically necessary, for pre-certification/re-certification; advising the
patient of discharge; and assisting with appeals for denials, when applicable.
✔✔CDC - ✔✔Centers for Disease Control and Prevention; one of the DHHS
Operating Divisions.
✔✔CDM - ✔✔charge description master; the chargemaster or master pricing list that
includes services, supplies, devices, and medication charges for inpatient or outpatient
services by a healthcare facility.
✔✔CERT - ✔✔Comprehensive Error Rate Testing.
,✔✔Certified application counselors - ✔✔individuals (staff members or volunteers) who
fulfill some of the same roles as Navigators and non-Navigators; they are not
responsible for outreach and education but they do provide free information to
consumers about insurance programs, they assist them in applying for coverage, and
they help to facilitate the enrollment in health coverage.
✔✔CHAMPUS - ✔✔Civilian Health and Medical Programs of the Uniformed
Services; the programs replaced by Tricare to cover healthcare for active duty and
retired members of the uniformed services, their families, and survivors.
✔✔Chapter 7 - ✔✔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 creditor claims; about
70% of all bankruptcy claims are filed under Chapter 7.
✔✔Chapter 11 - ✔✔a type of bankruptcy frequently referred to as a "reorganization"; it
gives a distressed business a reprieve from creditor claims while it continues to function
and works out a repayment plan.
✔✔Chapter 12 - ✔✔a type of bankruptcy for a family farmer with "regular annual
income."
✔✔Chapter 13 - ✔✔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 supervision and protection, may propose and carry out a repayment plan
under which creditors are paid over an extended period of time.
✔✔chargemaster - ✔✔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.
✔✔charity care - ✔✔service provided that is never expected to result in cash
✔✔SCHIP - ✔✔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 governments, and
administered by the states.
✔✔CLIA - ✔✔the Clinical Laboratory Improvement Amendment of 1988;
legislation requiring all clinical laboratory services furnished to
Medicare beneficiaries to be performed by a provider who has a CLIA certificate.
✔✔Clinical Laboratory Improvement Amendment (CLIA) of 1988 - ✔✔legislation
requiring all clinical laboratory services furnished to
, Medicare beneficiaries to be performed by a provider who has a CLIA
certificate.
✔✔CMP - ✔✔civil monetary penalty.
✔✔CMS - ✔✔Centers for Medicare and Medicaid Services; one of the DHHS
Operating Divisions.
✔✔CMS 1450 - ✔✔another name for the UB-04 uniform bill form.
✔✔CMS 1500 - ✔✔the billing form used to submit physician and professional
service claims to Medicare.
✔✔CO - ✔✔compliance officer.
✔✔COB - ✔✔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.
✔✔Common Working File - ✔✔a CMS file that contains Medicare patient
eligibility and utilization data.
✔✔conditional payment - ✔✔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.
✔✔Consumer assistance programs - ✔✔a resource to help to address consumers'
problems or questions about health coverage.
✔✔Consumer Credit Protection Act - ✔✔the first general federal consumer protection
legislation; its provisions include the Truth in Lending Act, the Fair Credit Billing Act, the
Fair Credit Reporting Act, and the Fair Debt Collection Practices Act.
✔✔coordination of benefits contractor - ✔✔a contracted entity that assists with the
collection, management, and reporting of other health coverage; COB contractors do
not process claims for the provider; they gather and disseminate coordination of
benefits information to ensure that Medicare is not making primary payment for a
service in error.
✔✔courtesy discharge - ✔✔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.
