Certified Revenue Cycle Specialist (CRCS)

1-Day Rule - ANSWER-requirement that all diagnostic or outpatient services furnished in connection with the principle admitting diagnosis within on day prior to the hospital admission are bundled with the inpatient services for Medicare billing 3-Day Rule - ANSWER-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 15000), formerly the 837P 837I - ANSWER-the American National Standards Institute transaction for an institutional claim; as a result of HIPAA , it is replacing the electronic UB-04 837P - ANSWER-a former American National Standards Institute transaction for a professional claim (the electronic equivalent of the CMS 15000), since replaced by the 5010A1 AMN - ANSWER-the Advance Beneficiary Notice of Non-coverage; 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 - ANSWER-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