2024 CRCR Exam 1 New Full Exam Questions and Answers ( Included ) 100% Correct
- Accountable Care Organization
Answer: Assumes 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
Answer: money owed by third-party payers and patients to the provider for health care services
- Advanced Beneficiary Notice
Answer: "waiver of liability"; medical providers are re- quired 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
Answer: report that shows accounts receivable totals by financial class and aging
- Ambulatory Payment Classificaiton
Answer: government'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
Answer: Monthly Gross Patient Service Revenue divided by Days in the month
- Bad Debt Agency
Answer: third-party that focuses on working self-pay claims including patient
balances remaining after insurance has paid
- Bundled Payment
Answer: the reimbursement of health care providers on the basis of expected costs for clinically-defined episodes of care
- Care Management
Answer: method of managing the provision of healthcare with the goal of improving continuity and quality of care while lowering cost
- / 3
- Case Mix Index
Answer: average DRG weight for all of a hospital's Medicare volume
- Centers for Medicare and Medicaid Services
Answer: US federal agency that administers Medicare rules and payment
- Charge Description Master
Answer: file that contains a list of chargeable services and the respective charge for the procedures
- Clearinghouse
Answer: third 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
Answer: using electronic tools to perform inpatient record review for the purpose of recognizing opportunities for documentation improvement
- Commercial Payer
Answer: third-party, non-government payer
- Contractual Allowance
Answer: the agreed amount that an insurance company will pay for specified services provided to one of its members
- Current Procedural Terminology Codes
Answer: codes 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
Answer: a claim that has been initially denied payment from a commercial or
government payer
- Diagnosis Related Group
Answer: system used to classify hospital cases into groups to determine how much government and commercial payers pay the hospital for each "product"
- Early Out
Answer: service that focuses on working self-pay claims including self-pay after insurance 2 / 3
- Electronic Data Interchange
Answer: structured transmission of data between organizations by electronic means
- Government Payers
Answer: Medicare, Medicaid, Tricare, and SCHIP
- Healthcare Common Procedure Coding System
Answer: coding system used to identify products, supplies, and services not included in the CPT-4 codes
- Healthcare Financial Management Association
Answer: leading 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
Answer: in- tended to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care
27. ICD-10
Answer: medical classification that provides codes to classify diseases and a wide variety of signs, symptoms and external causes of injury or disease
- Managed Care
Answer: health insurance that is intended to reduce costs through eco- nomic
incentives for physicians and patients to select less costly forms of care and other methods
- Medicaid Integrity Program
Answer: federal strategy to prevent and reduce fraud and abuse within Medicaid
- Medical Necessity
Answer: process to determine if services to be provided are medically necessary
based on criteria laid out by the insurance carrier
- Net Patient Service Revenue
- / 3
Answer: the revenue actually collected by hospitals for services provided to patients