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AAHAM CRCE 2025 EXAM STUDY GUIDE 100% CORRECT SOLUTIONS
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AAHAM CRCE 2025 EXAM STUDY GUIDE 100%CORRECT SOLUTIONS
1-day payment window rule - ANSWER a Medicare requirement comparable to the day
payment window rule applicable to inpatient psychiatric hospitals, inpatient
rehabilitation facilities, long-term care facilities, and children's and cancer hospital.
3-day payment window rule - ANSWER a Medicare requirement that all diagnostic and
clinically related nondiagnostic outpatient services furnished within three days of an
inpatient admission must combined the inpa- tient claim when they are furnished by an
entity wholly owned or oper ated by the inpatient hospital (or by another entity under
arrange ments with the admitting hospital).
8371 - ANSWER the dataset which is used to electronically transmit a claim for the
hospital to the payer.
837P - ANSWER the standard transaction under HIPAA which replaces the CMS-1500
and applies to nearly all physicians.
838 report - ANSWER one of the required quarterly credit balance report to track
identification and recovery of credit balances owed 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 and that directly or indirectly result 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
can also advise on coverage, and can only sell plans from designated health insurance
companies
AHA - ANSWER American Hospital Association
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