2024 CRCR Definitions | Complete Answers 100% Correct
- Access
Answer: Ability to Receive Hospital, Physician or other Medical Services without Regard to an Individual's Ability to Pay
- Accounts Receivable (A/R)
Answer: Money owed to an Organization for Goods or Services Furnished
- Accounts Receivable (A/R) Collection Period
Answer: Number of Days in the Accounting Period divided by the accounts
receivable turnover. This ratio tells you the average time it takes to collect amounts due.
- Accounts Receivable (A/R) Turnover
Answer: Services rendered on credit during the period divided by the A/R balance.This ration tells you how many times you collect your AR in a given cycle
- Accreditation
Answer: Formal 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 + health plans meet predetermined standards.
- Accredited Standards Committee X12 (ASC X12)
Answer: Group of Industry members that creates electronic data interchange
standards for submission to the American National Standards Institute for subsequent approval + Dissemination
- Acute Care
Answer: Hospital Care given to patients who generally require a stay up to seven days + that focuses on a physical or mental condition requiring immediate intervention + constant medical attention, equipment + personnel
- Administrative Services Only (ASO)
Answer: Contract between an insurance company or claims administrator + a self-
funded plan where the insurance company/claims administrator performs certain services but does not assume any risk; Services usually include claims processing but may also include such services as group billing, actuarial analysis, utilization review + provider network development
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- Admission
Answer: Formal Registration of a patient who is to be provided with medical care by the provider
- Admitting Diagnosis
Answer: Diagnosis provided on admission, explaining the reason for admission +
coded according to current diagnosis coding conventions
- Advance Beneficiary Notice (ABN)
Answer: The mandated form required to be used for Medicare beneficiaries related to non-covered services. Waiver that a provider has a patient sign confirming the patient's understanding that certain provided services may not be reimbursable under Medicare + therefore are the patient's responsibility
- Affiliation
Answer: Arrangement between organizations by which the names organizations
remain independent but have influence on each other; affiliations may or may not be permanent + may not result in common ownership or control of the affiliates
- After Care
Answer: Services Following Hospitalization or Rehabilitation
- Aging
Answer: Process wherein accounts receivable or accounts payable are scheduled,
listed, or arranged based on elapsed time from the date or service or transaction
- Aid to Families with Dependent Children (AFDC)
Answer: State Based Federal cash assistance program for low-income families
- AIDS Drug Assistance Programs (ADAP)
Answer: Joint Federal-state sponsored pro- grams that assist eligible HIV-positive patients in obtaining HIV medications
- All Inclusive Rate
Answer: Charge Rate established by a healthcare provider that covers all services a beneficiary may receive or be entitled to receive over a designated period of time
- Allied Health Personnel
Answer: Specially trained + licensed health worker other than physicians, dentists, optometrists, chiropractor, podiatrists + nurses.
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- Allowable Costs
Answer: Costs incurred by a provider in the course of providing ser- vices that are recognized as eligible for reimbursement by a third-party payer
- Allowable for Bad Debts
Answer: An estimate of the amount of accounts receivable that a healthcare
provider will be unable to collect; It reduces the value of accounts receivable
- Allowed Amount
Answer: Maximum amount Medicare will pay in a given area for covered service
- Ambulatory Care
Answer: Health Serviced rendered outside the inpatient setting
- American National Standards Institute (ANSI)
Answer: Parent organization of the ASC X12 + the recognized coordinator +
clearinghouse for the information on the U.S. + Canadian National Standards
- Ancillary Service
Answer: Those services other than room, board + medical and nursing services, such as laboratory, radiology, pharmacy + therapy services
- Appeal
Answer: Request by a provider or beneficiary to have coverage and/or payment
determination reconsidered
- Assignment
Answer: Agreement in which a patient transfers to a provider the right to the receive payment from a third party for the service the patient has received
- Attending Physician
Answer: Licensed physician who supervises the care + treatment of a patient
- Attestation
- names of the major procedures performed, which must be completed shortly
Answer: Physician's report attesting to the principal diagnosis, secondary diagnosis
before or shortly after the patient is discharged; signature of authorized representative affirming that information in a CMS enrollment application is true
- Audit
Answer: Methodical review and Objective examination of services performed,
verifying specific information as determined by the auditor as established by general
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