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AAHAM CRCS-P STUDY GUIDE EXAM 2022 COMPLETE DOCUMENT GRADED A
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AAHAM CRCS-P STUDY GUIDE EXAM 2022 COMPLETE DOCUMENT GRADED A
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AAHAM CRCS-P STUDY GUIDE EXAM 2022 COMPLETE DOCUMENTGRADED A
CRCS - Certified Revenue Cycle Specialist
AAHAM - The American Association of Healthcare Administrative Management
1-Day Rule - a requirement that all 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 - 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 - the American National Standards Institute transaction for a
professional claim (the electronic equivalent of the CMS 15000),
formerly the 837P
837I - the American National Standards Institute transaction for an
institutional claim; as a result of HIPAA, it is replacing the electronic
UB-04.
837P - a former American National Standards Institute transaction for a
professional claim (the electronic equivalent of the CMS 15000), sincereplaced by the 5010A1.
ABN - the 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 - 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,
pharmaceuticals, and services; abuse of authority; and abuse of privacy, confidentiality, or duty
to care; it also includes improper billing practices (like billing Medicare instead of primary
insurer), increasing charges to Medicare beneficiaries but not to other patients, unbundling of
services, and unnecessary transfers of
patients.
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.
ACF - Administration for Children and Families; one of the DHHS
Operating Divisions.
ACL - Administration for Community Living; one of the DHHS Operating
Divisions.
,actual or expressed consent - written or oral agreement by the patient to
the treatment outlined.
acute inpatient - a level of healthcare delivered to patients experiencing
acute illness or trauma; it generally occurs in a hospital or emergency room and is generally
short-term care rather than long-term or chronic care.
ADC - average daily census; the average number of inpatients maintained in the hospital each
day for a specific period of time.
ADRR - 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.
Advance Beneficiary Notice - the 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.
AFDC - Aid to Families with Dependent Children; a financial assistance
program provided by DHHS.
agents - 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.
AHA - the American Hospital Association.
AHRQ - Agency for Healthcare Research and Quality; one of the DHHS
Operating Divisions.
ALOS - average length of stay; a metric calculated by dividing the total
number of patient days by the number of discharges.
ancillary services - services other than routine room and board charges
that are incidental to the hospital stay; they include operating room; anesthesia; blood
administration; pharmacy; radiology; laboratory; medical, surgical, and central supplies;
physical, occupational, speech pathology, and inhalation therapies; and other diagnostic
services.
ANSI - the American National Standards Institute.
APC - 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 - annual percentage rate; one of the elements of disclosure required by the Truth in
Lending Act.
assignment of benefits - a written authorization, signed by the policyholder (or the patient, in
the absence of the policyholder) to an insurance company, to pay benefits directly to the
provider; when assignment is not accepted, the payment will be sent to the patient and the
provider will have to collect it.
ATB - aged trial balance; a resource for internal collection efforts.
ATSDR - Agency for Toxic Substances and Disease Registry; one of the
DHHS Operating Divisions.
average daily census - the average number of inpatients maintained in the
hospital each day for a specific period of time.
average daily revenue - the average amount of revenue or charges
generated each day over a specified period of time.
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.
bad debt - an uncollectible account resulting from the extension of credit.
beneficiary - a person who has healthcare insurance through Medicare
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
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