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CertifiedRevenue CycleSpecialist(CRCS-I, CRCS-P)ExamStudy Outline2014December 201311240 Waples Mill Road, Suite 200, Fairfax, VA 22030Phone: 703-281-4043 Fax: 703-359-7562 www.aaham.org

Copyright 2013American Association of Healthcare Administrative Management(AAHAM)All Rights ReservedNo part of this publication may be reproduced or transmitted in anyform or by any means, electronic or mechanical, including photocopy,recording or any information storage or retrieval system, withoutwritten permission from the AAHAM National Office in Fairfax, VA.

AcknowledgmentsThis study manual is the work of the following committed and creative group ofindividuals:Principal WriterBrenda Chambers, MHA, CRCE–I, CRCE-PInstructional DesignerDebra Halsey, Halsey & Co.ReviewersVictoria Di Tomaso, CRCE-ILaurie Shoaf, CRCE-IChristine Stottlemyer, CRCE-IContributorsSharon Galler, CMPMaria LeDoux, CAEAmanda Leibert

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ContentsContents1IntroductionOverview of this Outline . 1-1Knowledge and Skill Requirements for Certification . 1-1Icons . 1-1Glossary . 1-2An Alternative to this Outline . 1-2Overview of CRCS-I and CRCS-P Exams . 1-2Dual Certification . 1-3Eligibility. 1-3Applications, Fees, and Deadlines . 1-3Applications . 1-3Fees . 1-4Deadlines . 1-4Exam Format and Grading . 1-4Retake Criteria . 1-5Suggested Preparation . 1-5Exam Logistics . 1-6Re-certification . 1-72Federal Regulations and Governing BodiesKnowledge and Skill Requirements . 2-13Patient Access ServicesKnowledge and Skill Requirements . 3-14Hospital and Clinic BillingKnowledge and Skill Requirements . 4-15Credit and CollectionsKnowledge and Skill Requirements . 5-1Glossary . 6-1 AAHAMi

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Certified Revenue Cycle Specialist (CRCS-I, CRCS-P) Exam Study Outline - 2014Introduction1 IntroductionOverview of this OutlineThe American Association of Healthcare Administrative Management(AAHAM) offers this Certified Revenue Cycle Specialist (CRCS-I, CRCS-P)Exam Study Outline – 2014 to help you prepare for the Certified RevenueCycle Specialist (CRCS-I, Institutional Billing, or CRCS-P, ProfessionalBilling) examination.Knowledge and Skill Requirements forCertificationThis outline lists the requirements for each broad topic covered in theexam. Pay careful attention to the wording of the requirements, as itindicates specifically what you must be able to do in order to achievecertification. For example: Describe common metrics related to collection.The wording of this requirement tells you that you should be able todescribe the metrics. You should understand the definitions and conceptsin these metrics so you can describe them. However, you won't need to doany calculations since the word “calculate” is not used in the requirement.IconsMost of the requirements apply to both exams. When a requirementapplies to only one exam, it is flagged with an icon as shown in theexample below: Describe the use of common or required billing and statement“forms.”–SuperbillI–UB-04 (and 837I) (including common codes)P–CMS 1500 (and 5010A1/837P) (including common codes andinstructions to complete the form)–Itemized Statement–Data Mailer–Medicare Summary Notice AAHAM (Rev. 12/15/2013)Confidential and Proprietary1-1

Certified Revenue Cycle Specialist (CRCS-I, CRCS-P) Exam Study Outline - 2014IntroductionGlossaryThere is an extensive glossary at the back of this outline.TIP: It will be extremely helpful when taking the exam if you are very familiarwith the terms and definitions in the glossary.An Alternative to this OutlineShould you want a more comprehensive and robust study aid, considerpurchasing the AAHAM Certified Revenue Cycle Specialist (CRCS-I, CRCSP) Exam Study Manual - 2014. Like this outline, the study manual lists thespecific skill and knowledge requirements you must meet to achievecertification. However, the study manual also includes extensiveinformation you can review to prepare for the exam. In addition, the studymanual has Knowledge Checks where you can test your ability to applywhat you have learned, with answer keys so you can assess your progress.To purchase the Certified Revenue Cycle Specialist (CRCS-I, CRCS-P) ExamStudy Manual - 2014, please visit our website at www.aaham.org.Overview of CRCS-I and CRCS-P ExamsIntroduced in 1992 as the Certified Patient Accounts Technician (CPAT) orCertified Clinic Accounts Technician (CCAT) certification and renamedCRCS-I and CRCS-P in 2013, these exams test staff proficiency andprovide a resource for patient account managers to ensure staffingcompetence. The exams test overall understanding of healthcare patientaccounting in the areas of admitting, billing, and collections, along withthe knowledge of industry-standard abbreviations.Successful completion will establish individuals as being proficient andcompetent. Further, the designation, sponsored by AAHAM, will providerecognition from your peers and healthcare executives nationally. In manyinstances, certification can help you get the job or promotion you reallywant.1-2 AAHAM (Rev. 12/15/2013)Confidential and Proprietary

Certified Revenue Cycle Specialist (CRCS-I, CRCS-P) Exam Study Outline - 2014IntroductionDual CertificationDual certification exams are available to current CRCS-I’s or CRCS-P’sonly. You cannot take both the CRCS-I and CRCS-P exams during thesame exam cycle. CRCS-I Dual Exam – for a current CRCS-P individual desiring tobecome certified CRCS-P Dual Exam – for a current CRCS-I individual desiring tobecome certifiedEach dual exam consists of two sections covering patient access servicesand communications/registration, and third party billing regulations.EligibilityAny person involved in the admitting, billing, or collection of patientaccounts in healthcare is eligible for the CRCS-I/CRCS-P exams.Membership in AAHAM is not a requirement, although it is encouraged.One year of experience in clinical or hospital patient accounting isrecommended.Applications, Fees, and DeadlinesApplicationsThere are two ways to apply for an exam: Online – go to www.aaham.org; use the online application link on thecertification page; and pay with a credit card (amount describedunder Fees below). Mail in – obtain an application from www.aaham.org, Certificationtab. Complete and mail the application with a check or money order(amount described under Fees below), payable to AAHAM, to:National AAHAMAttention Tech Cert11240 Waples Mill Rd., Ste. 200Fairfax, VA 22030If you have any further questions or would like to request a copy of thecertification brochure, contact the AAHAM national office at 703-281-4043,ext. 211 or send an e-mail to amanda@aaham.org. AAHAM (Rev. 12/15/2013)Confidential and Proprietary1-3

Certified Revenue Cycle Specialist (CRCS-I, CRCS-P) Exam Study Outline - 2014IntroductionFeesExamination fees are: Full CRCS-I/CRCS-P examination:– Dual certification examination:– 80Section retake (described under Retake Criteria below):– 100 50CCT examination:– 100DeadlinesThe application and fee must be received by: March 1 for the May exam June 1 for the August exam September 1 for the November exam December 1 for the February examExam Format and GradingThe examination has three sections: Patient access services and communication/registration Third party billing Credit and collections, and third party follow upEach section also includes relevant regulations and acronyms, and consistsof 40 multiple-choice questions, for a total of 120 questions.A grading report will appear after you submit your results at thecompletion of your exam. If a printer is available, you may print yourscores. These scores will also be sent to you via e-mail to the e-mailaddress you provide on your application.You must attain a score of at least 70% in each section to pass that section,and you must pass all three sections to pass the exam. (For dual exams,1-4 AAHAM (Rev. 12/15/2013)Confidential and Proprietary

Certified Revenue Cycle Specialist (CRCS-I, CRCS-P) Exam Study Outline - 2014Introductionyou must score at least 70% in each of the two sections, both of whichconsist of 40 multiple-choice questions.)Certificates will be sent to your Chapter Certification Chair approximatelythree weeks after the closing of the examination window. The Chapterwill present certificates in one of these ways: Present passing examinees their certificates at an AAHAM Chaptermeeting. Mail certificates to the addresses provided on exam applications. (Email amanda@aaham.org if you wish to verify your mailing address.)Retake CriteriaIf you pass at least two of the sections but fail the third, you can retake theremaining section within 12 months of the initial exam month. In order toretake a section, you must:1. Complete another application for the failed section.2. Remit a check or money order for 50.3. Submit the application and fee to the national AAHAM office by theappropriate deadline (see Deadlines above) in order to retake the examwithin 12 months of the initial examination month.(For dual exams, you must pass both sections on the same exam day. Ifyou fail to pass both sections on exam day, you must retake the entireexam.)Suggested PreparationIndependent research and hands-on experience will be necessary in orderto successfully complete the exam. Be sure to allow enough time for all thepreparation you want to do. Finding a “study-buddy” can be very helpful;try to pair up with another person in your chapter and take the examtogether.Many chapters offer coaching sessions to help members prepare. We wantyou to succeed; therefore, we urge you to attend these sessions.TIP: Because it is one of the largest payers, there are many Medicare questionson the exam. Be sure to be well-versed on Medicare issues and know all currentMedicare deductibles and coinsurance amounts. AAHAM (Rev. 12/15/2013)Confidential and Proprietary1-5

Certified Revenue Cycle Specialist (CRCS-I, CRCS-P) Exam Study Outline - 2014IntroductionExam LogisticsThe Chapter Certification Chair determines the exact dates, times, andlocations of exams. You should hear from your Chapter CertificationChair by the 7th of your examination month via phone, e-mail, or letter,using the information you provided on your application. If you do nothear from your Chapter Certification Chair by the 7th of that month,contact him or her directly. (There is a directory of Chapter CertificationChairs in the certification section of the AAHAM website,www.aaham.org.)TIP: Examinations are offered quarterly based on proctor availability, usuallyduring the second and third weeks of February, May, August, and November.For further details, see the home page of www.aaham.org and view theCalendar of Events area.The day of the exam, you will need current photo identification. You willalso need your AAHAM exam confirmation that contains your Test TakerAuthorization Code, which you will receive via e-mail approximately 1-2weeks before your exam date. You will be unable to take the examwithout your Test Taker Authorization Code.WARNING: You will not be able to use study guides, written and/or electronicnotes, or verbal and/or signaled help during the exam. Examinees who witnessthis conduct are required to report it to the examination proctor.Plan your arrival approximately 15 minutes prior to the examination. Thisallows you ample time should delays or problems present themselves.Failure to arrive on time will negate sitting for the exam, and result inforfeiture of the application. There are no refunds or postponements, andexam fees are non-transferab

Certified Revenue Cycle Specialist (CRCS-I, CRCS-P) Exam Study Outline - 2014 Introduction AAHAM (Rev. 12/15/2013) 1-3 Confidential and Proprietary Dual Certification Dual certification exams are available to current CRCS-I’s or CRCS-P’s only. You cannot take both the CRCS-I and CRCS-P exams during the same exam cycle.