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CRCR C questions with answers
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Exam of 16 pages for the course crcr at crcr (CRCR C Exam)
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CRCRAccountable Care Organization - answerAssumes responsibility for the care of a clearly
defined population of Medicare beneficiaries attributed to it on the basis of their pattern
of use of primary care; Groups of doctors, hospitals, and other health care providers,
who come together voluntarily to give coordinated high quality care to their Medicare
patients
Accounts Receivable - answermoney owed by third-party payers and patients to the
provider for health care services
Advanced Beneficiary Notice - answer"waiver of liability"; medical providers are required
to give a patient notice when they offer services or items that they know or have reason
to believe Medicare will determine to be medically unnecessary, and therefore will not
pay for
Aged Trial Balance - answerreport that shows accounts receivable totals by financial
class and aging
Ambulatory Payment Classificaiton - answergovernment's method of paying for facility
outpatient services for Medicare when a patient is discharged or transferred to another
facility not affiliated with the initial treatment facility
Average Daily Gross Revenue - answerMonthly Gross Patient Service Revenue divided
by Days in the month
Bad Debt Agency - answerthird-party that focuses on working self-pay claims including
patient balances remaining after insurance has paid
Bundled Payment - answerthe reimbursement of health care providers on the basis of
expected costs for clinically-defined episodes of care
Care Management - answermethod of managing the provision of healthcare with the
goal of improving continuity and quality of care while lowering cost
,Case Mix Index - answeraverage DRG weight for all of a hospital's Medicare volume
Centers for Medicare and Medicaid Services - answerUS federal agency that
administers Medicare rules and payment
Charge Description Master - answerfile that contains a list of chargeable services and
the respective charge for the procedures
Clearinghouse - answerthird party agency that settles accounts, clears claims and acts
as an intermediary between healthcare providers and insurance to process or facilitate
the processing of information
Clinical Documentation Integrity - answerusing electronic tools to perform inpatient
record review for the purpose of recognizing opportunities for documentation
improvement
Commercial Payer - answerthird-party, non-government payer
Contractual Allowance - answerthe agreed amount that an insurance company will pay
for specified services provided to one of its members
Current Procedural Terminology Codes - answercodes assigned to every task and
service a medical practitioner may provide to a patient used to determine the amount of
reimbursement that a practitioner will receive by an insurer
Denial - answera claim that has been initially denied payment from a commercial or
government payer
Diagnosis Related Group - answersystem used to classify hospital cases into groups to
determine how much government and commercial payers pay the hospital for each
"product"
Early Out - answerservice that focuses on on working self-pay claims including self-pay
after insurance
Electronic Data Interchange - answerstructured transmission of data between
organizations by electronic means
Government Payers - answerMedicare, Medicaid, Tricare, and SCHIP
Healthcare Common Procedure Coding System - answercoding system used to identify
products, supplies, and services not included in the CPT-4 codes
Healthcare Financial Management Association - answerleading membership
organization for health care financial management executives and leaders
, Hospital-Acquired Condition - answer"Never Events"; CMS will withhold payments to
hospitals for specific conditions that a patient acquires while an inpatient that could be
"reasonably prevented" by following established evidence-based guidelines
Hospital Consumer Assessment of Healthcare Providers and Systems - answerintended
to provide a standardized survey instrument and data collection methodology for
measuring patients' perspectives on hospital care
ICD-10 - answermedical classification that provides codes to classify diseases and a
wide variety of signs, symptoms and external causes of injury or disease
Managed Care - answerhealth insurance that is intended to reduce costs through
economic incentives for physicians and patients to select less costly forms of care and
other methods
Medicaid Integrity Program - answerfederal strategy to prevent and reduce fraud and
abuse within Medicaid
Medical Necessity - answerprocess to determine if services to be provided are
medically necessary based on criteria laid out by the insurance carrier
Net Patient Service Revenue - answerthe revenue actually collected by hospitals for
services provided to patients
Physician Quality Reporting System - answerestablished a financial incentive for eligible
health care professionals to participate in a voluntary quality reporting program
Readmissions - answera subsequent hospital admission in the same or different
hospital within 30 days following the original admission
Recovery Audit Contractors - answerthe auditing branch of CMS that retrospectively
reviews Medicare payments and ultimately possesses the authority to take payment
back from the healthcare providers
Revenue Cycle - answerthe process that includes patient access, care management,
HIM, patient accounting
Transaction Services - answerEDI services designed to automate manual RevCycle
processes, increase efficiency and reduce costs
Uncompensated Care - answerthe sum of uncollected charges
UB-04 - answerthe current version of the e-billing platform established and agreed to by
the National Uniform Billing Committee to bill institutional services
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