AAHAM CRCS Study Guide Questions And
Correct Answers
1 |Day |Rule |- |ANSWER |A |requirement |that |wall |diagnostic |or |outpatient |services
|furnished |in |connection |with |the |principle |admitting |diagnosis |within |one |day |prior |to |the
|hospital |admission |are |bundled |with |the |inpatient |services |for |Medicare |billing.
3 |Day |Rule |- |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
5010A1 |- |ANSWER |the |American |National |Standards |Institute |transaction |for |a
|professional |claim |(the |electronic |equivalent |of |the |CMS |1500), |formerly |the |837P
837I |- |RESPONSE |the |American |National |Standards |Institute |transaction |for |an
|institutional |claim; |because |of |HIPAA |this |is |taking |the |place |of |the |electronic |UB-04
837P |- |RESPONSE |an |older |American |National |Standards |Institute |transaction |for |a
|professional |claim |(what |used |to |be |the |electronic |equivalent |of |the |CMS |1500), |now
|replaced |by |the |5010A1
ABN |- |ANSWER |the |Advanced |Beneficiary |Notice |of |Non-coverage: |a |written |notice
|provided |to |a |Medicare |beneficiary |prior |to |the |supply |of |services |given |a |service |does
|not |meet |or |is |not |expected |to |meet |medical |necessity.
abuse |the |act |of |misusing |a |person, |substance, |service, |or |financial |matter |such |that
|harm |results; |some |forms |of |healthcare |abuse |include |excessive |or |unjustified |use |of
|technology, |pharmaceuticals, |and |services; |abuse |of |authority; |and |abuse |of |privacy,
|confidentiality, |or |duty |to |care; |it |also |includes |improper |billing |practices, |increasing
|charges |to |medicare |beneficiaries |but |not |to |other |patients, |unbundling |of |services, |and
|unnecessary |transfers |of |patients.
,Accounts |Receivable |(AR) |Days |Outstanding |- |ANSWER |an |estimate, |using |average
|current |revenues, |of |the |days |required |to |turn |over |the |accounts |receivable |under |normal
|operating |conditions; |in |other |words, |this |is |a |best |estimate |of |how |long |it |will |take |to
|collect |the |accounts |receivable.
ACF |- |ANSWER |Administration |for |Children |and |Families; |one |of |the |DHHS |Operating
|Divisions
ACL |- |ANSWER |Administration |for |Community |Living; |one |of |the |DHHS |Operating |Divisions
informed |consent |- |ANSWER |verbal |or |written |agreement |by |the |patient |to |the |treatment
|described.
acute |inpatient |- |ANSWER |a |level |of |care |provided |to |patients |who |are |suffering |from
|acute |sickness |or |injury; |it |is |usually |given |in |a |hospital |or |emergency |room |and |is |usually
|short-term |care |as |opposed |to |long-term |or |chronic |care.
ADC |- |ANSWER |average |daily |census; |the |average |number |of |inpatients |maintained |in |the
|hospital |each |day |for |a |specific |period |of |time.
ADRR |- |ANSWER |also |referred |to |as |Accounts |Receivable |(AR) |Days |Outstanding; |refer |to
|definition |under |Accounts |Receivable |(AR) |Days |Outstanding
Advanced |Beneficiary |Notice |- |ANSWER |also |referred |to |as |ABN; |refer |to |definition |under
|ABN
AFDC |- |ANSWER |Aid |to |Families |with |Dependent |Children; |a |DHHS |provided |cash
|assistance
agents |- |ANSWER |persons |that |help |consumers |and |small |business |owners |through |the
, application |process |and |enrollment |into |healthcare |coverage |on |the |Marketplace; |are |able
|to |counsel |about |coverage |and |sell |only |plans |from |designated |health |insurance
|companies
AHA | - | ANSWER | American | Hospital | Association
AHRQ |- |ANSWER |Agency |for |Healthcare |Research |and |Quality; |one |of |the |DHHS |operating
|Divisions
ALOS |- |ANSWER |average |length |of |stay; |a |metric |calculated |by |dividing |the |total |number |of
|patient |days |but |the |number |of |discharges
ancillary |services |- |ANSWER |services |other |than |routine |room |and |board |charges |that
|are |incidental |to |the |hospital |stay; |they |include |operation |room; |anesthesia; |blood
|administration; |pharmacy; |radiology; |laboratory; |medical, |surgical, |and |central
|supplies; |physical, |occupational, |speech |pathology, |and |inhalation |therapies; |and |other
|diagnostic |services.
ANSI-ANSWER | the | American | National | Standards | Institute
APC-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
APR-ANSWER |annual |percentage |rate; |one |of |the |elements |of |disclosure |required |by |the
|Truth |in |Lending |Act
assignment |of |benefits |- |ANSWER |a |written |authorization, |signed |by |the |policyholder |(or
|patient, |in |the |absence |of |the |policyholder) |to |an |insurance |company, |to |pay |benefits
|directly |tot |he |provider; |when |assignment |is |not |accepted, |the |payment |will |be |sent |to |the
|patient |and |the |provider |will |have |to |collect |it
Correct Answers
1 |Day |Rule |- |ANSWER |A |requirement |that |wall |diagnostic |or |outpatient |services
|furnished |in |connection |with |the |principle |admitting |diagnosis |within |one |day |prior |to |the
|hospital |admission |are |bundled |with |the |inpatient |services |for |Medicare |billing.
3 |Day |Rule |- |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
5010A1 |- |ANSWER |the |American |National |Standards |Institute |transaction |for |a
|professional |claim |(the |electronic |equivalent |of |the |CMS |1500), |formerly |the |837P
837I |- |RESPONSE |the |American |National |Standards |Institute |transaction |for |an
|institutional |claim; |because |of |HIPAA |this |is |taking |the |place |of |the |electronic |UB-04
837P |- |RESPONSE |an |older |American |National |Standards |Institute |transaction |for |a
|professional |claim |(what |used |to |be |the |electronic |equivalent |of |the |CMS |1500), |now
|replaced |by |the |5010A1
ABN |- |ANSWER |the |Advanced |Beneficiary |Notice |of |Non-coverage: |a |written |notice
|provided |to |a |Medicare |beneficiary |prior |to |the |supply |of |services |given |a |service |does
|not |meet |or |is |not |expected |to |meet |medical |necessity.
abuse |the |act |of |misusing |a |person, |substance, |service, |or |financial |matter |such |that
|harm |results; |some |forms |of |healthcare |abuse |include |excessive |or |unjustified |use |of
|technology, |pharmaceuticals, |and |services; |abuse |of |authority; |and |abuse |of |privacy,
|confidentiality, |or |duty |to |care; |it |also |includes |improper |billing |practices, |increasing
|charges |to |medicare |beneficiaries |but |not |to |other |patients, |unbundling |of |services, |and
|unnecessary |transfers |of |patients.
,Accounts |Receivable |(AR) |Days |Outstanding |- |ANSWER |an |estimate, |using |average
|current |revenues, |of |the |days |required |to |turn |over |the |accounts |receivable |under |normal
|operating |conditions; |in |other |words, |this |is |a |best |estimate |of |how |long |it |will |take |to
|collect |the |accounts |receivable.
ACF |- |ANSWER |Administration |for |Children |and |Families; |one |of |the |DHHS |Operating
|Divisions
ACL |- |ANSWER |Administration |for |Community |Living; |one |of |the |DHHS |Operating |Divisions
informed |consent |- |ANSWER |verbal |or |written |agreement |by |the |patient |to |the |treatment
|described.
acute |inpatient |- |ANSWER |a |level |of |care |provided |to |patients |who |are |suffering |from
|acute |sickness |or |injury; |it |is |usually |given |in |a |hospital |or |emergency |room |and |is |usually
|short-term |care |as |opposed |to |long-term |or |chronic |care.
ADC |- |ANSWER |average |daily |census; |the |average |number |of |inpatients |maintained |in |the
|hospital |each |day |for |a |specific |period |of |time.
ADRR |- |ANSWER |also |referred |to |as |Accounts |Receivable |(AR) |Days |Outstanding; |refer |to
|definition |under |Accounts |Receivable |(AR) |Days |Outstanding
Advanced |Beneficiary |Notice |- |ANSWER |also |referred |to |as |ABN; |refer |to |definition |under
|ABN
AFDC |- |ANSWER |Aid |to |Families |with |Dependent |Children; |a |DHHS |provided |cash
|assistance
agents |- |ANSWER |persons |that |help |consumers |and |small |business |owners |through |the
, application |process |and |enrollment |into |healthcare |coverage |on |the |Marketplace; |are |able
|to |counsel |about |coverage |and |sell |only |plans |from |designated |health |insurance
|companies
AHA | - | ANSWER | American | Hospital | Association
AHRQ |- |ANSWER |Agency |for |Healthcare |Research |and |Quality; |one |of |the |DHHS |operating
|Divisions
ALOS |- |ANSWER |average |length |of |stay; |a |metric |calculated |by |dividing |the |total |number |of
|patient |days |but |the |number |of |discharges
ancillary |services |- |ANSWER |services |other |than |routine |room |and |board |charges |that
|are |incidental |to |the |hospital |stay; |they |include |operation |room; |anesthesia; |blood
|administration; |pharmacy; |radiology; |laboratory; |medical, |surgical, |and |central
|supplies; |physical, |occupational, |speech |pathology, |and |inhalation |therapies; |and |other
|diagnostic |services.
ANSI-ANSWER | the | American | National | Standards | Institute
APC-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
APR-ANSWER |annual |percentage |rate; |one |of |the |elements |of |disclosure |required |by |the
|Truth |in |Lending |Act
assignment |of |benefits |- |ANSWER |a |written |authorization, |signed |by |the |policyholder |(or
|patient, |in |the |absence |of |the |policyholder) |to |an |insurance |company, |to |pay |benefits
|directly |tot |he |provider; |when |assignment |is |not |accepted, |the |payment |will |be |sent |to |the
|patient |and |the |provider |will |have |to |collect |it
