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AAHAM CRCS Study Guide Questions And Correct Answers
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AAHAM CRCS Study Guide Questions AndCorrect Answers
1 Day Rule - ANSWER A requirement that wall 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 - ANSWER 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 - ANSWER the American National Standards Institute transaction for a
professional claim (the electronic equivalent of the CMS 1500), formerly the 837P
837I - RESPONSE the American National Standards Institute transaction for an
institutional claim; because of HIPAA this is taking the place of the electronic UB-04
837P - RESPONSE an older American National Standards Institute transaction for a
professional claim (what used to be the electronic equivalent of the CMS 1500), now
replaced by the 5010A1
ABN - ANSWER the Advanced Beneficiary Notice of Non-coverage: a written notice
provided to a Medicare beneficiary prior to the supply of services given a service does
not meet or is not expected to meet medical necessity.
abuse the act of misusing a person, substance, service, or financial matter such that
harm results; some forms of healthcare abuse include excessive or unjustified use of
technology, pharmaceuticals, and services; abuse of authority; and abuse of privacy,
confidentiality, or duty to care; it also includes improper billing practices, increasing
charges to medicare beneficiaries but not to other patients, unbundling of services, and
unnecessary transfers of patients.
,Accounts Receivable (AR) Days Outstanding - ANSWER an estimate, using average
current revenues, of the days required to turn over the accounts receivable under
normal operating conditions; in other words, this is a best estimate of how long it will
take to collect the accounts receivable.
ACF - ANSWER Administration for Children and Families; one of the DHHS Operating
Divisions
ACL - ANSWER Administration for Community Living; one of the DHHS Operating
Divisions
informed consent - ANSWER verbal or written agreement by the patient to the treatment
described.
acute inpatient - ANSWER a level of care provided to patients who are suffering from
acute sickness or injury; it is usually given in a hospital or emergency room and is
usually short-term care as opposed to long-term or chronic care.
ADC - ANSWER average daily census; the average number of inpatients maintained in
the hospital each day for a specific period of time.
ADRR - ANSWER also referred to as Accounts Receivable (AR) Days Outstanding; refer
to definition under Accounts Receivable (AR) Days Outstanding
Advanced Beneficiary Notice - ANSWER also referred to as ABN; refer to definition
under ABN
AFDC - ANSWER Aid to Families with Dependent Children; a DHHS provided cash
assistance
agents - ANSWER persons that help consumers and small business owners through the
, application process and enrollment into healthcare coverage on the Marketplace; are
able to counsel about coverage and sell only plans from designated health insurance
companies
AHA - ANSWER American Hospital Association
AHRQ - ANSWER Agency for Healthcare Research and Quality; one of the DHHS
operating Divisions
ALOS - ANSWER average length of stay; a metric calculated by dividing the total number
of patient days but the number of discharges
ancillary services - ANSWER services other than routine room and board charges that
are incidental to the hospital stay; they include operation room; anesthesia; blood
administration; pharmacy; radiology; laboratory; medical, surgical, and central
supplies; physical, occupational, speech pathology, and inhalation therapies; and other
diagnostic services.
ANSI-ANSWER the American National Standards Institute
APC-ANSWER 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-ANSWER annual percentage rate; one of the elements of disclosure required by the
Truth in Lending Act
assignment of benefits - ANSWER a written authorization, signed by the policyholder (or
patient, in the absence of the policyholder) to an insurance company, to pay benefits
directly tot he provider; when assignment is not accepted, the payment will be sent to
the patient and the provider will have to collect it
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