AAHAM CRCE 2023 EXAM STUDY GUIDE Questions With Complete Solutions
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Course
AAHAM
Institution
AAHAM
1-day payment window rule correct 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 correct answer:...
AAHAM CRCE 2023 EXAM STUDY
GUIDE Questions With Complete
Solutions
1-day payment window rule correct 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 correct 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 correct answer: the dataset that is utilized to electronically
submit hospital claims to the payer.
837P correct answer: the HIPAA standard transaction that replaces the CMS-1500 and is required of almost all physicians.
838 report correct answer: a mandatory quarterly credit balance report used to monitor identification and recovery of credit balances owed to Medicare. Advance Beneficiary Notice ABN correct answer: Document that acknowledges patient responsibility for payment if Medicare denies the claim.
Agents correct answer: individuals to help consumers and small
businesses complete the application process and enroll in health coverage through the Marketplace
Abuse correct 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 correct answer: a method of accounting that generally recognizes income in the period earned and recognizes
deductions in the period that liabilities are incurred.
ACF correct answer: Administration for Children and Families one of HHS operating divisions
ACL correct answer: Administration for Community Living; one of the HHS Operating Divisions.
Americans with Disabilities Act, ADA correct answer: Comprehensive legislation that is designed to protect individuals
with disabilities against discrimination. Advanced alternative payment models, APMs correct 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 correct answer: the third level of both the Medicare and RAC appeals process
Advance beneficiary notice correct answer: Document that acknowledges patient responsibility for payment if Medicare denies the claim.
agents correct 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 correct answer: American Hospital Association
AHRQ correct answer: Agency for Healthcare Research and Quality; one of the HHS Operating Divisions
ANSI correct answer: American National Standards Institute
Anti-Kickback Statute correct answer: Prohibits offering, paying, soliciting or receiving anything of value to induce or reward referrals or generate federal healthcare program business.
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