Healthcare Terminology and Concepts, Exams of Nursing

Download Healthcare Terminology and Concepts and more Exams Nursing in PDF only on Docsity! 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 Record - 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. 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. 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.