CRCR EXAM 151 Questions with Answers 2023,100% CORRECT

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CRCR EXAM 151 Questions with Answers 2023 835 Record - CORRECT ANSWERSA standard electronic message between a health plan and provider sending remittance data on a claim to the provider. 837 R... ecord - CORRECT ANSWERSA standard electronic message between a provider and health plan sending data on a claim to the health plan. AAR - CORRECT ANSWERSAfter-hours activity report ABN - CORRECT ANSWERSAdvanced Beneficiary Notice ACC - CORRECT ANSWERSambulatory care center Access - CORRECT ANSWERSThe ability to receive hospital, physician or other medical services without regard to an individuals ability to pay. Accountable Care Organization (ACO) - CORRECT ANSWERSA coordinated group of healthcare providers (including physicians, hospitals, and other types of providers) organized to improve quality and lower the cost of care to a defined group of patients. Accounting Identity - CORRECT ANSWERSAlso known as the accounting equation; assets = liabilities + equity. Accounts Payable - CORRECT ANSWERSA current liability where funds are owed to suppliers. Accounts Payable Distribution - CORRECT ANSWERSAn account computer system report that details the amounts paid to vendors by date, purchase order, and expense classification. Accounts receivable (A/R) - CORRECT ANSWERSMoney owed to an organization for goods or services furnished. A/R Collection Period - CORRECT ANSWERSNumber of days in the accounting period divided by accounts receivable turnover. This ratio tells you the average time it takes to collect amounts due. A/R Turnover - CORRECT ANSWERSServices rendered on credit during the period divided by the A/R balance. This ratio tells you how many times you collect your AR in a given cycle. Accounts Receivable Aging - CORRECT ANSWERSA report that summarizes accounts receivable from different sources (such as Medicare or commercial insurance) by thirty day increments. Accreditation - CORRECT ANSWERSFormal process by which an agency or organization evaluates and recognizes a program as meeting certain predetermined criteria or standards. A formal process for certifying that providers and health plans meet predetermined standards. Accredited Standards Committee X12 (ASC X12) - CORRECT ANSWERSA committee of the American National Standards Institute (ANSI) responsible for the development and maintenance of electronic data interchange (EDI) standards for many industries. The ASC 'X12N' is the subcommittee of ASC X12 responsible for the EDI health insurance administrative transactions such as 837 Institutional Health Care Claim and 835 Professional Health Care Claim forms Accrual - CORRECT ANSWERSAn expense or a revenue that occurs before the business pays or receives cash. An accrual is the opposite of a deferral. Accrual Basis Accounting - CORRECT ANSWERSThe method of accounting that recognizes revenue when it is earned and matches expenses to the revenues they helped produce Accrued Payroll and Benefits - CORRECT ANSWERSAn estimate of salaries and associated benefit costs (such as payroll tax matching) earned by employees but not yet paid by the employer. Accumilated Depreciation - CORRECT ANSWERSA balance sheet account where the total amount of depreciation recognized as expense over time is compiled. ACS - CORRECT ANSWERSAmbulatory Care Services Activity Based Costing - CORRECT ANSWERSA technique to assign product costs based on links between activities that drive costs and the production of specific products. acuity - CORRECT ANSWERSA measure of the severity of an illness or the resources required to treat an illness or injury. acute care hospital - CORRECT ANSWERSA hospital where patients are treated for brief but severe episodes of illness, injury, trauma, or during recovery from surgery. Patients who require a stay up to 7 days and that focus on physical or mental condition requiring immediate intervention and constant medical attention, equipment, and personnel. AD - CORRECT ANSWERSadmitting diagnosis Administrative cost - CORRECT ANSWERSIn a health plan, those expenses not paid for medical costs on behalf of plan members; but instead associated with administrative functions such as sales, customer services, claims processing, and finance. Administrative Load Ratio - CORRECT ANSWERSIn a health plan, the percentage of total premiums collected expended for administrative costs. Administrative services only (ASO) - CORRECT ANSWERSContract where a third-party administrator or insurer provides administrative services to an employer for a fixed fee per employee. Services usually include claims processing but may also include such services as group billing, actuarial analysis, utilization review, and provider network development. admission - CORRECT ANSWERSFormal registration of a patient who is to be provided with medical care by the provider. Admitting diagnosis - CORRECT ANSWERSThe patient's condition determined by a physician at admission to an inpatient facility for admission and coded according to current diagnosis coding conventions. ADP - CORRECT ANSWERSAutomated Data Processing ADR - CORRECT ANSWERSAverage Daily Revenue ADRG - CORRECT ANSWERSAdjacent diagnosis-related group; alternative diagnosis related group. ADS - CORRECT ANSWERSAlternative delivery system ADSC - CORRECT ANSWERSAverage Daily Service Charge ADT - CORRECT ANSWERSadmission, discharge, transfer Advance Beneficiary Notice (ABN) - CORRECT ANSWERSDocument that acknowledges patient responsibility for payment if Medicare denies the claim. Advanced Practice Provider (APP) - CORRECT ANSWERSClinical nurse specialists (CNS), nurse practitioners (NPs) and Physician Assistants (PAs). AFDC - CORRECT ANSWERSAid to Families with Dependent Children AFDS - CORRECT ANSWERSAlternative financing and delivery systems Affiliation - CORRECT ANSWERSArrangement between organizations by which the named organizations remain independent but have influence on each other; affiliations may or may not be permanent and my not result in common ownership or control of the affiliates. After care - CORRECT ANSWERSServices following hospitalization or rehabilitation. Aging - CORRECT ANSWERSProcess wherein accounts receivable or accounts payable are scheduled, listed or arranged based on elapsed time from date of service or transaction. AHA - CORRECT ANSWERSAmerican Hospital Association AHP - CORRECT ANSWERSallied health professional AHRQ - CORRECT ANSWERSAgency for Healthcare Research and Quality Aid to Families with Dependent Children (AFDC) - CORRECT ANSWERSFederal funds for children in families that fall below state standards of need. In 1996, Congress abolished AFDC, the largest federal cash transfer program, and replaced it with the Temporary Assistance for Needy Families (TANF) block grant AIDS Drug Assistance Programs (ADAP) - CORRECT ANSWERSJoint federal-state sponsored programs that assist eligible HIV-positive patients that assist eligible HIV-positive patients in obtaining HIV medications. ALC - CORRECT ANSWERSalternate level of care All inclusive rate - CORRECT ANSWERSa fixed amount charged on a daily basis during a patient's hospitalization or a total rate charged for an entire stay allied health professionals - CORRECT ANSWERSHealthcare professionals who support the work of physicians and perform specific services ordered by the physician. Allied health professionals include nurses, technologists, technicians, therapists, dentists, optometrists, chiropractors, podiatrists, and others. Allowable Costs - CORRECT ANSWERSCosts that are allowed under the terms of the contract. Typically, allowable costs become relevant under certain types of cost-reimbursable contracts where the buyer reimburses the seller's allowable costs. If there are non-allowable costs in a contract, the buyer is not obligated to reimburse the seller for these. allowance for bad debts - CORRECT ANSWERSA contra asset account, related to accounts receivable, that holds the estimated amount of uncollectible accounts. Allowed amount - CORRECT ANSWERSThe maximum amount Medicare will pay for any given area for a covered service. ambulatory care - CORRECT ANSWERSServices that do not require an overnight hospital stay. Services rendered outside the impatient setting. Ambulatory Patient Groups (APGs) - CORRECT ANSWERSInstitutional outpatient reimbursement system based on the methodology developed by CMS; APCs/APGs are to outpatient visits/services what DRGs are to inpatient hospital admissions; the payments are based on categories or groupings of like or similar services requiring like or similar professional services and supply utilization. Ambulatory Payment Classification (APC) - CORRECT ANSWERSProspective payment system used to calculate reimbursement for outpatient care according to similar clinical characteristics and in terms of resources required. Ambulatory setting - CORRECT ANSWERSA type of health care setting where health servies are provided on an outpatinet basis. Ambulatory setting usually include physician's offices, clinics, and surgery centers AMCC - CORRECT ANSWERSAutomated multi-channel chemistry American National Standards Institute (ANSI) - CORRECT ANSWERSParent organization of the ASC X12 and the recognized coordinator and clearinghouse for information on United States and Canadian national standards. Ancillary Services - CORRECT ANSWERSSupportive services other than routine hospital services provided by the facility, such as x-ray films and laboratory tests. Anniversary - CORRECT ANSWERSThe beginning of a subscriber group's benefit year. ANSI - CORRECT ANSWERSAmerican National Standards Institute APC - CORRECT ANSWERSAmbulatory Payment Classification APG - CORRECT ANSWERSAmbulatory patient group APHP - CORRECT ANSWERSAcute partial hospitalization program APP - CORRECT ANSWERSAdvanced Practice Provider Appeal - CORRECT ANSWERSRequest by a provider or beneficiary to have coverage and/or payment determination reconsidered. AR - CORRECT ANSWERSaccounts receivable AS - CORRECT ANSWERSAdmission scheduling ASC - CORRECT ANSWERSAdministrative services contract; ambulatory surgical/surgery center ASF - CORRECT ANSWERSAmbulatory surgical facility ASO - CORRECT ANSWERSAdministrative Services Only Asset - CORRECT ANSWERSAnything of value that is owned Assignment - CORRECT ANSWERSAgreement in which a patient transfers to a provider the right to receive payment from a third party for the service the patient has received. Attending physician - CORRECT ANSWERSMedical staff member who is legally responsible for the care and treatment given to a patient. Attestation - CORRECT ANSWERSPhysician's report attesting to the principal diagnosis, secondary diagnosis, and names of the major procedures performed, which must be completed shortly before or shortly after the patient is discharged; signature of authorized representative affirming that information in a CMS enrollment application is true. Audit - CORRECT ANSWERSMethodical review and objective examination of services performed, verifying specific information as determined by the auditor or as established by general practice. Audit trail - CORRECT ANSWERSAccounting records that trace transactions from their source documents to the financial statements Average Daily Census (ADC) - CORRECT ANSWERSThe average inpatient census (excluding newborns) receiving care each day over a given period of time. Average length of stay (ALOS) - CORRECT ANSWERSAverage stay counted by days of all or a class of inpatients discharged over a given period, calculated by dividing the number of inpatient days by the number of discharges. BAA - CORRECT ANSWERSBusiness Associate Agreement Bad debt - CORRECT ANSWERSUnpaid customers' bills that are now very unlikely to ever be paid Balance billing - CORRECT ANSWERSBilling patients for charges in excess of the Medicare fee schedule. Balance Sheet - CORRECT ANSWERSA financial statement that reports assets, liabilities, and owner's equity on a specific date. Statement that lists the financial resources (assets), financial obligations (liabilities), and ownership rights (equity/fund balance) within the organization. Balanced Budget Act of 1997 (BBA) - CORRECT ANSWERSFederal legislation, passed by Congress and signed by President Clinton, that cut health care expenditures for Medicare and other government-sponsored programs to achieve a balanced budget Bankruptcy - CORRECT ANSWERSFederal system of marshaling the assets of a financially distressed person or organization and paying the creditors' on a pro rata basis. Batch control tasks - CORRECT ANSWERSFigures that ensure batch processing has been performed correctly by comparing output to the input totals, record or document counts, or cash totals. batch processing - CORRECT ANSWERSAccumulating transaction records into groups or batches for processing at a regular interval such as daily or weekly. The records are usually sorted into some sequence (such as numerically or alphabetically) before processing. BBA - CORRECT ANSWERSBalanced Budget Act of 1997 behavioral health - CORRECT ANSWERSHealthcare services, such as those provided by a psychiatrist, psychologist, social worker, hospital, or other facility duly licensed and qualified to treat mental health and chemical dependency conditions. Benchmarking - CORRECT ANSWERSProcess of identifying industry standards and best practices. Benchmarks - CORRECT ANSWERSIndustry standards for specific tasks or performance normally set by surveying groups and comparing data across groups. Beneficiary - CORRECT ANSWERSA person on behalf of which an insurance plan payment is made to a healthcare provider. Benefit days - CORRECT ANSWERSDays that a patient is eligible for covered services. benefit package - CORRECT ANSWERSThe set of services, such as physician visits, hospitalizations, prescription drugs, that are covered by an insurance policy or health plan. The benefit package will specify any cost-sharing requirements for services, limits on particular services, and annual or lifetime spending limits. Benefit payment - CORRECT ANSWERSA payment by an insurer based on the terms of an insurance policy on behalf of a plan beneficiary or member. Benefit year - CORRECT ANSWERSthe 12-month period for which health insurance benefits are calculated, not necessarily coinciding with the calendar year. Health insurance companies may update plan benefits and rates at the beginning of the benefit year. Billed charges - CORRECT ANSWERSThe amount the provider bills to the payer for a specific item or service such as a visit to a physician or an inpatient day at a healthcare facility; gross prices charged for healthcare services. Same as submitted charges Billing - CORRECT ANSWERSSubmission of a claim for payment for services rendered by a healthcare provider to the insured or to the patient. Billing and collection function - CORRECT ANSWERSAlso known as patient financial services or PFS, the function in a healthcare provider entity that compiles and submits claims to insurers or patients and collects amounts due for services. BIPA - CORRECT ANSWERSSCHIP benefits improvement and protection act of 2000 Bond issue - CORRECT ANSWERSThe selling of a number of small debt instruments to multiple lenders. Bottom up approach - CORRECT ANSWERSA budgeting system whereby budgets originate at the department or program level and then are aggregated and approved by senior managers break-even analysis - CORRECT ANSWERSa method of determining what sales volume must be reached before total revenue equals total costs and operate at a zero profit. BSR - CORRECT ANSWERSBill Summary Period Budgeting - CORRECT ANSWERSProcess of formulating a comprehensive management plan of operation that formally expresses both broad and specific objectives and sets standards for the evaluation of performance. Bundled Payments - CORRECT ANSWERScategory of payments made as lump sums to providers for all healthcare services delivered to a patient for a specific illness and/or over a specified time period; they include multiple services and may include multiple providers of care Bundling - CORRECT ANSWERSA method used by insurance companies that combines reimbursement for two or more medical services into one payment in full. If an insurance company doesn't feel a medical procedure should be paid individually, it will combine the payment of one item with another, thus reducing its total cost. Business Intelligence - CORRECT ANSWERSanalyzing large amounts of data for strategic decision making Bylaws - CORRECT ANSWERSOrganizational document for for-profit and not-for-profit organizations that supplements the articles of incorporation, establishes procedural rules not found in the articles of incorporation or enabling statute, and is not a public document. C and E - CORRECT ANSWERSConsultation and examination CAH - CORRECT ANSWERSCritical Access Hospital Calculation for adjusted discharge - CORRECT ANSWERSFor adjusted discharges or patient days; adjusted discharges (days) = inpatient discharges (days) x (1 = [gross outpatient revenue/gross inpatient revenue]) capital assets - CORRECT ANSWERSAssets of a permanent nature used in the production of income, such as land, buildings, machinery, and equipment; usually distinguishable under income tax law from "inventory," assets held for sale to customers in the ordinary course of the taxpayer's trade or business capital budget - CORRECT ANSWERSA budget that describes the expected capital acquisitions (equipment, buildings) for a business during a specific period of time. capital lease - CORRECT ANSWERSA contractual agreement allowing one party (the lessee) to use another party's asset (the lessor); accounted for like a debt-financed purchase by the lessee. A lease with or without the eventual opportunity to purchase the asset. Capital Structure Ratios - CORRECT ANSWERSFinancial rations that evaluate the mix of debt and equity in a business. Capitation - CORRECT ANSWERSSystem of payment used by managed care plans in which physicians and hospitals are paid a fixed, per capita amount for each patient enrolled over a stated period regardless of the type and number of services provided; reimbursement to the hospital on a per-member/per-month basis to cover costs for the members of the plan. Care purchaser - CORRECT ANSWERSIndividual or entity that contributes to the purchase of healthcare services Carrier - CORRECT ANSWERSInsurer of a group contract that agrees to underwrite (accept the risk) and to provide certain types of insurance coverage. Carve Out - CORRECT ANSWERSSet of health plan benefits that are contracted separately from the standard benefits package case management - CORRECT ANSWERSMethod of managing the provision of healthcare with the goal of improving continuity and quality of care while lowering cost. Case Manager - CORRECT ANSWERSClinical professional who works with patients, providers, families, and insurers to coordinate all the services deemed necessary to care for the patient in the best and lowest cost medically appropriate setting. Case Mix Index - CORRECT ANSWERSThe average relative weight of all cases treated at a given facility or by a given physician, which reflects the resource intensity or clinical severity (acuity) of a specific group in relation to the other groups in the classification system Case Rate - CORRECT ANSWERSPayment to a provider for all care for a specific service, such as a surgery or treatment of an illness. Cash - CORRECT ANSWERSAlso called currency. It is used to determine liquidity ratios and transact financial business. Cash is considered the most liquid of all assets. Cash Basis of Accounting - CORRECT ANSWERSContrasted with the accrual basis of accounting, this basis of accounting records revenues and expenses in the period in which expense payments are made or revenues are collected. Cash budget - CORRECT ANSWERSa detailed plan showing how cash resources will be acquired and used over a specific time period Categorical Eligibility - CORRECT ANSWERSEligibility for a benefit program based solely on one's demographic characteristics. Categorically needy - CORRECT ANSWERSPersons whose Medicaid eligibility is based on their family, age, or disability status. CCH - CORRECT ANSWERSCommerce Clearinghouse CCI - CORRECT ANSWERSCorrect Coding Initiative CCMU - CORRECT ANSWERSCritical care medical unit CCO - CORRECT ANSWERSChief Compliance Officer CCU - CORRECT ANSWERScardiac care unit CD - CORRECT ANSWERSchemical dependency ceiling - CORRECT ANSWERSDollar amount above which amounts would be disallowed or rejected. CELIP - CORRECT ANSWERSClaims Expansion and Line Item Processing. Medicare's expanded claim form necessary to perform medical reviews and capture savings at the line item level under the outpatient PPS system. Census - CORRECT ANSWERSCount of patients who at the time counted were duly registered in a provider's care, normally on an inpatient basis; Count of all people in the United States taken every ten years by the federal government; Listing of all eligible members who are to be covered by a plan. Centers for Medicare and Medicaid Services (CMS) - CORRECT ANSWERSa federal agency within the U.S. Department of Health and Human Services that is responsible for Medicare and Medicaid, among many other responsibilities. certificate - CORRECT ANSWERSDocument or benefits booklet issued to a covered individual and a group health insurance plan setting forth the benefits and requirements of that plan Certificate of Medical Necessity (CMN) - CORRECT ANSWERSSigned physician attestation document stating services provided under a specific course of treatment are medically necessary. CHAMPUS - CORRECT ANSWERSCivilian Health and Medical Program of the Uniformed Services. The Department of Defense administers this program, which pays for healthcare delivered by civilian health providers to retired members and dependents of active members for all military services in the U.S. CHAMPVA - CORRECT ANSWERSCivilian Health and Medical Program of the Veterans Administration Change in Net Assets - CORRECT ANSWERSThe amount of change in Net Assets recorded as a result of earnings during an accounting period. See also Net income Channeling - CORRECT ANSWERSProcedure used in managed care or point-of-service plans as a means of steering or encouraging patients to a specific network of providers through the use of incentives. Patients who use a network provider may be responsible for a lower co-payment and/or receive higher insurance benefits then if accessing an out-of-network provider. Charge - CORRECT ANSWERSThe dollar amount a provider sets for services rendered before negotiating any discounts. The charge can be different from the amount paid. charge-based reimbursement - CORRECT ANSWERSPayment to health care provider based on billed charges and not on a prospectively negotiated amount. Charge capture - CORRECT ANSWERSThe process of recording a charge for a service or item on a patient's account. Chargemaster - CORRECT ANSWERSA listing of all items for which revenue can be generated in a healthcare provider organization; also referred to as the CDM or charge description master. [Show More]

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