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AAHAM CRCE 2024 EXAM STUDY GUIDE QUESTIONS AND ANSWERS
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AAHAM CRCE 2024 EXAM STUDY GUIDE QUESTIONS AND ANSWERS
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AAHAM CRCE 2024 EXAM STUDYGUIDE
1-day payment window rule - 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 - 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 - Answer -the dataset that is utilized to electronically submit hospital claims to the payer.
837P - Answer -the HIPAA standard transaction that replaces the CMS-1500 and is required of almost all
physicians.
838 report - Answer -a mandatory quarterly credit balance report used to monitor identification and
recovery of credit balances owed to 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
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 - 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 are able to make recommendations
about coverage and may only sell plans from specific health insurance companies
AHA - Answer -American Hospital Association
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