AAHAM Certified Revenue Cycle Executive (CRCE) Practice Exam

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• Which of the following best defines what “medically unlikely edit” (MUE) aims to target?
• What is the term for consent given when a patient is informed of the risks and benefits of medical services?
• What is the role of the primary care physician (PCP) in patient care?
• Which bankruptcy option is often described as a reorganization plan for businesses?
• What type of exclusion applies to providers convicted of Medicare fraud?
• What is the term for when a claim is rejected entirely, allowing billing teams to correct and resubmit it, but not appeal?
• Which term describes the practice of authorizing payment directly to the physician for billed charges?
• What is the definition of Durable Medical Equipment (DME)?
• What does a DNR order permit?
• What is the primary purpose of the Fair Debt Collection Practices Act?
• Which federal law ensures the confidentiality and accuracy of consumer reporting agencies?
• What document communicates a patient's wishes regarding medical treatments?
• What does the 837P transaction replace?
• What document designates a health care proxy for making decisions on behalf of an incapacitated client?
• What is the role of an inpatient rehabilitation facility?
• What is a key feature of a Coordinated Care Plan (CCP) in relation to health insurance?
• What is the function of the Implied Consent in Fact?
• Which act is primarily concerned with preventing fraud in federal healthcare programs?
• What does the Healthcare Common Procedure Coding System (HCPCS) standardize?
• What is the minimum data set (MDS) in the context of Medicare?
• Which of the following is related to managing appeals in the Medicare system?
• What term describes the percentage at which a payer will reimburse a provider?
• What is the final level of both the Medicare and the RAC appeals process?
• What type of care is limited to 60 days of services after exhausting the initial benefits?
• What is the nature of a complex review in RAC processes?
• What is the typical duration of care necessary for an inpatient admission to be considered acute care?
• What does the evaluation and management process entail?
• What term refers to the percentage of allowable charges that a patient must pay after meeting their deductible?
• What does AHA stand for in the context of healthcare?
• Which law outlines when Medicare is considered the primary payer?
• What does "cost to collect" refer to in healthcare revenue management?
• What type of care requires hospital admission for at least two midnights according to a doctor's orders?
• What is the primary purpose of the 1-day payment window rule?
• In the context of patient care, what is an exception to the requirement for informed consent?
• In which scenario would a provider submit the CMS-1500 form?
• What does the acronym DNFB stand for in healthcare billing context?
• What defines factoring of receivables without recourse?
• Which file contains Medicare patient eligibility and utilization data?
• What agency aims to improve the quality of healthcare through research?
• What is the purpose of a Mini Miranda statement?
• What role do agents play in the health coverage Marketplace?
• What is the term for an individual entitled to both Medicare and Medicaid benefits?
• What characterizes Chapter 11 Bankruptcy?
• Which service encompasses physical therapy, occupational therapy, and speech-language therapy in the home setting?
• Which payment system reimburses providers for each medical service rendered?
• What is the name of the private firm that processes Medicare claims?
• What is a DMERC?
• What term refers to care provided to a patient who is unable to pay and meets specific charity care guidelines?
• Which bankruptcy option provides a way for individuals to pay a portion of their debts while keeping their property?
• What implies consent when a patient does not object to treatment?
• Which of the following best describes Average Length of Stay (ALOS) in healthcare?
• What determines which parent's insurance coverage is primary for a child covered by both?
• What is the purpose of the 838 report?
• How many hours must an employee have worked in the last 12 months to qualify for FMLA leave?
• What does AR Days measure in the revenue cycle?
• Which aspect does the MUE focus on to reduce errors?
• What federal agency regulates food and drug products sold to the public?
• Which of the following pertains to the evaluation and management process?
• What organization is recognized for accrediting hospitals and improving the quality and safety of care?
• What does the Medicare Beneficiary Identifier (MBI) replace?
• What law allows treatment of an unconscious patient in emergency situations?
• What type of care is provided to terminally ill patients that focuses on comfort?
• What is one potential benefit of the meaningful use initiative?
• What is referred to as a type of claim skip due to provider error?
• What is the mandated code set used for diagnoses and inpatient procedures called?
• What does CMS stand for in the context of healthcare regulations and services?
• Which type of bankruptcy allows for a division of assets among creditors due to no means to repay debts?
• Which law has played a role in determining when Medicare is the primary payer?
• In the Medicare appeals process, what is the third level of appeal called?
• Which type of Medicare Advantage plan is known for being the most restrictive?
• How does the 837 transaction contribute to healthcare administration?
• Which of the following describes procedures to protect assets from theft?
• What does ATSDR stand for?
• Which dataset is utilized by hospitals to electronically submit claims to the payer?
• Which legislation prohibits offering free or discounted services to referring physicians?
• Which healthcare facility typically provides long-term rehabilitation services?
• What legislation is responsible for the registration, certification, and inspection of laboratory sites to ensure quality testing?
• What is the primary focus of the Federal Trade Commission?
• Which type of Medicare plan replaces traditional fee-for-service Medicare?
• What are the 60 days of inpatient hospital services, used after the initial 90 days, termed?
• What constitutes harassment in the workplace?
• What metric represents the average number of patient days per discharge?
• What is a courtesy discharge?
• What is a key function of the CMS policies in the context of MUE?
• What is a characteristic of the Ambulatory Payment Classification (APC) system?
• What does 'abuse' refer to in the context of healthcare services?
• Why is the monitoring of credit balances important for Medicare?
• What is the accrual method of accounting?
• What is the primary purpose of Asset Control in a healthcare organization?
• What type of care includes skilled nursing and therapy services at home?
• Which act establishes requirements for resolving billing disputes?
• Under which Act can employees take unpaid leave for family or health reasons?
• What methodology is used to establish payment for outpatient services by Medicare?
• What is the primary goal of using certified EHR technology?
• What is prohibited by the Anti-Kickback Statute?
• What type of program provides financial advance without risk of liability to the provider?
• What is a conditional payment in Medicare terms?
• What is contained in an itemized statement provided to patients?
• What is the Medicare Outpatient Observation Notice (MOON) developed for?
• What term refers to intentional deception for personal gain in a healthcare context?
• What is the objective of the minimum data set (MDS) in nursing homes?
• What important information can be found in an itemized statement related to healthcare services?
• Who assists consumers in understanding health coverage options without being responsible for outreach?
• What is an example of a form of inappropriate workplace conduct?
• What entity audits Medicaid claims to identify overpayment and can look back 5 years?
• What is the main focus of the 837 transaction?
• What type of power of attorney allows decisions regarding healthcare to be made on behalf of an individual?
• Which agency is known as AHRQ?
• Charity care is specifically designed to assist which group of patients?
• What is meant by the 3-day payment window rule?
• What is the term for rejecting a specific line on a billing claim without the option to appeal?
• What is the primary purpose of the ERISA?
• What does the average daily census reflect in healthcare settings?
• What does the term "meaningful use" refer to in healthcare?
• In the context of RAC reviews, what does an Automated review involve?
• What is the purpose of the initial enrollment questionnaire mailed to patients before they become entitled to Medicare?
• What characterizes factoring of receivables with recourse?
• What is the purpose of the MSP questionnaire?
• Which of the following is included in Durable Medical Equipment?
• What type of information is typically included in the MSP questionnaire?
• Which federal law is designed to protect against unfair billing practices?
• Which of the following best describes an intentional skip in debt repayment?
• Which of the following best describes a charged item in a chargemaster?
• What is a Coordinated Care Plan (CCP) typically associated with?
• Which document would typically allow an individual to appoint someone to make healthcare decisions for them?
• What is the electronic file of all charges that might be posted to a patient account known as?
• What type of payment arrangements are made to prevent beneficiaries from paying out of pocket initially?
• What does the Geographic Practice Cost Index adjust for in healthcare payments?
• What is the term used for an individual who has healthcare coverage under Medicare?
• What describes a situation where false information is deliberately provided to avoid repaying a debt?
• Which type of Medicare Advantage plan is least restrictive?
• Which legislation is aimed at protecting individuals with disabilities from discrimination?
• Which document provides details about patients being in observation status?
• What is NOT a function of a healthcare agent?
• What does EOB stand for in the context of healthcare billing?
• What does local coverage determination (LCD) refer to in healthcare?
• What is the purpose of a living will?
• What is the role of a certified application counselor?
• What is the primary purpose of Medicare as it relates to the elderly?
• How is Average Daily Census (ADC) calculated?
• Which of the following factors are considered in MUE?
• What does Chapter 13 Bankruptcy allow debtors to do?
• What is a judgment in the context of debt collection?
• What service do call centers provide in relation to health coverage?
• What is an Advance Beneficiary Notice (ABN)?
• What is another term for Medicare Part C?
• What does ANSI stand for in the context of standards organizations?
• In the context of healthcare funding, what can the meaningful use of EHR systems help providers achieve?
• Which program is associated with providing health insurance primarily for children?
• What document do hospitals provide to beneficiaries regarding noncoverage for certain procedures?
• What is the term for a patient's written authorization allowing an insurance company to pay the physician directly?
• What does case management involve in healthcare?
• Who are individuals that assist consumers with the health care coverage application process called?
• Which entity is responsible for the regulations surrounding Medicare and Medicaid services?
• What type of care is classified as acute and is expected to last for more than 25 days?
• In the context of Medicare, what is an important factor affecting the reimbursement rate?
• In healthcare, what does the term 'utilization review' most commonly refer to?
• Who are agents in the context of health coverage enrollment?
• What is a primary goal of the Americans with Disabilities Act?
• What term describes a temporary substitute for a doctor or member of the clergy?
• What is the purpose of Chapter 12 Bankruptcy?
• What form of care is referred to as custodial care and typically offered in nursing homes?
• What is primarily used to identify medical services and procedures provided by healthcare professionals?
• What is the fourth level of the Medicare and RAC appeals process?
• How do MUEs contribute to the quality of healthcare billing?
• When considering the efficiency of coding, what does MUE specifically address?
• What does CPT stand for in medical coding?
• What is the main focus of the Hospital Readmission Reduction Program?
• What calculation determines the midnight census in a hospital setting?
• What occurs during a dismissal of bankruptcy?
• What is a recorded claim against real or personal property that typically arises from a debt?
• Which health insurance program is also known as Title XIX?
• Who are the primary recipients of the Medicare program?
• Which of the following is true about coinsurance?
• What payment methodology is used by Medicare's OPPS to place services into groups based on similar clinical characteristics?
• What does CHNA stand for in the context of healthcare?
• What is a primary goal of ensuring accurate billing practices in healthcare?
• What does "Initiation" refer to in the context of health care?
• Which program monitors hospital readmissions and impacts payment reductions?
• What should patients be informed about regarding their noncoverage for specific procedures?
• What document indicates a patient's responsibility for payment if Medicare denies a claim?
• What is the primary objective of HIPAA?
• What type of claim denial occurs when the claim is suspended for medical review within the Medicare system?
• What document is presented to all Medicare beneficiaries shortly after admission to a hospital?
• Which of the following statements is true about the interaction of EHR technology with meaningful use?
• What does the Administration for Children and Families (ACF) fall under?
• Which of the following best describes the function of medically unlikely edits (MUE)?
• What does ERA refer to in medical billing?
• What does DMEPOS stand for?
• What is one consequence of failing to recognize abuse in healthcare practices?
• What role is one of the seven elements of a compliance plan as per OIG standards?
• Which form is the standard claim form used to submit physician and professional service claims when a provider qualifies for a waiver from HIPAA?
• Which agency is responsible for enforcing debt collection laws?
• What does the Medical Savings Account (MSA) Medicare Advantage plan consist of?
• What does the abbreviation "DME" represent?
• What is a key benefit of a fee-for-service payment model?
• What federal law governs self-insured plans?
• What are Advanced Alternative Payment Models (APMs) designed to incentivize?
• What type of consent is inferred from a patient’s actions or inaction?
• Which organization oversees the enforcement and auditing of healthcare claims?
• What does the term "conflict of interest" refer to in health care arrangements?
• Which of the following relates to ensuring quality in laboratory testing?
• Which act governs the use of consumer credit reports and personal information?
• Which of the following contributes to the determination of a service as "medically unlikely"?
• Which of the following describes fraud in a healthcare setting?
• What does ACL stand for in the context of HHS Operating Divisions?
• Which type of denial involves the rejection of one line of the UB claim?
• What is capitation in healthcare payment models?
• Which act protects consumers from abusive practices by creditors and collection agencies?