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Certified Revenue Cycle Specialist (CRCS) Exam Study Outline 2022IntroductionTIP: 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.Exam LogisticsThe exam can be taken online in the physical presence of a proctor, or remotely online through ProctorU. Your local AAHAM chapter can assist inhelping you secure a location and a proctor for your exam date. You willreceive an email from AAHAM approximately 1-2 weeks prior to yourexam date with instructions for setting up your account in our testing website.Plan to arrive approximately 15 minutes prior to the examination and havea photo ID to present to the proctor.You will be given a maximum of two hours to complete the exam.You may bring a nonprogrammable calculator and pen or pencil. The proctor will provide blank paper. No electronic devices (such as cell phones orflash drives) are allowed in the exam area. Personal belongings such aspurses and briefcases must be left with the proctor for the entire exam.There are no refunds or postponements for the CRCS exam.RecertificationTo retain the CRCS certification designation, two options are available:1. Retake and pass the entire exam every three years.2. Join as a National member prior to your certification expiration dateand earn continuing education units (CEUs). Please note that yourCEUs begin to accumulate starting the date you join as a Nationalmember; therefore, any CEUs earned before joining AAHAM as amember aren't eligible. Members must earn and report 30 CEUs priorto their certification expiration date. Fifteen of the CEUs must be obtained from attendance at AAHAM-related educational programs. Ifmembership and CEUs are not maintained, the designation will be revoked and can no longer be used. AAHAM (Rev. 1/1/2022)Confidential and Proprietary1-7

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Certified Revenue Cycle Specialist (CRCS) Exam Study Outline 2022Federal Agencies and Regulations2 Federal Agencies andRegulationsKnowledge and Skill RequirementsNOTE: The boxes and icons (“F” for facilities and “P” for provider practices)clarify requirements that typically apply to either a facility or provider practice,but not both. But remember that all the knowledge and skill requirements applyto your exam, regardless of whether it is flagged for facilities or providerpractices. The certification you are testing for and its exam are no longerseparated by facility versus provider practice distinction.In order to achieve certification, you should be able to:1. List federal agencies playing a major role in healthcare and healthcarechange: Department of Health and Human Services, its operating divisions, and Office of Inspector General.2. Describe the role of the Centers for Medicare & Medicaid Services andOffice of Inspector General.3. Name major federal regulations affecting healthcare and describe theirimpact in the following areas:–Patient rights–Administrative simplification–Affordable care–Anti-fraud and abuse–Telephone consumer protection–Credit and collections–Patient anti-dumping–Performance improvement AAHAM (Rev. 1/1/2022)Confidential and Proprietary2-1

Certified Revenue Cycle Specialist (CRCS) Exam Study Outline 2022Federal Agencies and Regulations4. Describe the role of The Joint Commission.2-2 AAHAM (Rev. 1/1/2022)Confidential and Proprietary

Certified Revenue Cycle Specialist (CRCS) Exam Study Outline 2022Patient Access / Front Office3 Patient Access / FrontOfficeKnowledge and Skill RequirementsNOTE: The boxes and icons (“F” for facilities and “P” for provider practices)clarify requirements that typically apply to either a facility or provider practice,but not both. But remember that all the knowledge and skill requirements applyto your exam, regardless of whether it is flagged for facilities or providerpractices. The certification you are testing for and its exam are no longerseparated by facility versus provider practice distinctionIn order to achieve certification, you should be able to:1. Describe the primary functions and responsibilities of Patient Access /Front Office related to:–Scheduling–Preadmission and preregistration–Precertification and preauthorization–Registration and admission–Insurance verification–Financial counseling–Collection–Compliance2. Describe the purpose, completion, triggering events, and retention ofthe Advance Beneficiary Notice of Noncoverage (ABN).FI3. Describe the use of the Hospital Issued Notice of Noncoverage(HINN). AAHAM (Rev. 1/1/2022)Confidential and Proprietary3-1

Certified Revenue Cycle Specialist (CRCS) Exam Study Outline 2022Patient Access / Front OfficeF4. Describe the roles and responsibilities of Case Management / Utilization Review.5. Identify the different levels of patient care.6. Differentiate between general and special consent forms and definevarious types of consent.7. Define assignment of benefits.8. Define emancipation.9. Describe the purpose and general composition of a medical recordand precautions for handling medical records.10. List individuals who can accept verbal (telephone) orders from a referring physician and required elements of a verbal order.11. Define the different types of coverage determinations.12. Describe Medicare Secondary Payer provisions including the use ofthe Initial Enrollment Questionnaire, MSP Questionnaire, and Common Working File.13. Describe the purpose and importance of Patient Access / Front Officefollowing a financial policy and strategies to comply with the policy.P14. Explain when and how a practice can terminate a patient-physician relationship.15. Describe the formulas for key performance indicators in Patient Access / Front Office.3-2 AAHAM (Rev. 1/1/2022)Confidential and Proprietary

Certified Revenue Cycle Specialist (CRCS) Exam Study Outline 2022Billing4 BillingKnowledge and Skill RequirementsNOTE: The boxes and icons (“F” for facilities and “P” for provider practices)clarify requirements that typically apply to either a facility or provider practice,but not both. But remember that all the knowledge and skill requirements applyto your exam, regardless of whether it is flagged for facilities or providerpractices. The certification you are testing for and its exam are no longerseparated by facility versus provider practice distinctionIn order to achieve certification, you should be able to:1. Describe types of insurance and insurance �� compensation–TRICARE–Children’s Health Insurance Program (CHIP)–Self-insurance–Commercial insurance–Liability insurance–Self-pay–Health Savings Accounts (HSAs)2. Determine proper coordination of benefits.3. Describe common HIPAA-required standard transaction sets andcodes.4. Describe the purpose and components of a National Drug Code. AAHAM (Rev. 1/1/2022)Confidential and Proprietary4-1

Certified Revenue Cycle Specialist (CRCS) Exam Study Outline 2022Billing5. Identify payment methodologies:FI–Medicare Severity Diagnosis-Related Group (MS-DRG)–Ambulatory Payment Classification (APC)–Fee Schedule–Resource-Based Relative Value Scale (RBRVS)–Usual, Customary, and Reasonable (UCR)–Skilled Nursing Facility Prospective Payment System (SNF PPS)–Critical Access Hospital (CAH)–Capitation–Per Diem–Percent of Charges–Fee-for-Service6. Describe the purpose and components of a chargemaster and bestpractices to update the file.7. Explain the purpose and importance of insurance payer contracts.8. Identify circumstances under which a Locum Tenens physician canbill.9. Describe common/required billing forms.FI–List common codes used to complete the UB-04/837I form.P–Describe standards to support optimal processing of the CMS1500/837P form.10. Explain mandatory filing requirements and exceptions.11. Identify and describe the importance of billing time frames.12. Describe key claim processing edits.13. Describe guidelines for an effective compliance plan.4-2 AAHAM (Rev. 1/1/2022)Confidential and Proprietary

Certified Revenue Cycle Specialist (CRCS) Exam Study Outline 2022Credit and Collections5 Credit and CollectionsKnowledge and Skill RequirementsNOTE: The boxes and icons (“F” for facilities and “P” for provider practices)clarify requirements that typically apply to either a facility or provider practice,but not both. But remember that all the knowledge and skill requirements applyto your exam, regardless of whether it is flagged for facilities or providerpractices. The certification you are testing for and its exam are no longerseparated by facility versus provider practice distinctionIn order to achieve certification, you should be able to:1. Define terms related to credit and collections.2. Explain how the statute of limitations affects collection efforts.3. Identify elements of an effective collection policy.4. Describe typical self-pay options, along with advantages and disadvantage s of key options.5. Identify common types of bankruptcy, how they affect the collectionprocess, and possible outcomes.6. Identify the responsible party for a given scenario.FI7. Define and list advantages of a courtesy discharge.8. List common delays/stalls of third-party payers.9. Identify common debt collection methods and practices.10. List generally accepted accounting principles for the cashier’s role.11. Describe common metrics related to collection. AAHAM (Rev. 1/1/2022)Confidential and Proprietary5-1

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Certified Revenue Cycle Specialist (CRCS) Exam Study Outline 2022GlossaryGlossary1-day payment window rule a Medicare requirement similar to the 3day payment window rule that applies to inpatient psychiatric hospitals, inpatient rehabilitation facilities, long term care facilities, and children’s and cancer hospital.3-day payment window rule a Medicare requirement that all diagnosticand clinically related non-diagnostic outpatient services providedwithin three days of an inpatient admission must be combined to the inpatient claim when they are provided by an entity wholly owned or operated by the inpatient hospital (or by another entity under arrangements with the admitting hospital).837I the dataset that is utilized to electronically submit hospital claims tothe payer.837P the billing form used to electronically submit physician and professional service claims to the payer.ABN see Advance Beneficiary Notice.abuse incidents or practices of healthcare workers that, although notusually considered fraudulent, are inconsistent with accepted soundpractices.Accounts Receivable (AR) Days Outstanding another name for AverageDays of Revenue in Accounts Receivable (ADRR); an estimate, using average current revenues, of the days required to turn over the accountsreceivable under normal operating conditions; in simple terms, this is anestimate of the time needed to collect the accounts receivable.ACF Administration for Children and Families; one of the HHS Operating Divisions.ACL Administration for Community Living; one of the HHS OperatingDivisions.actual or expressed consent written or oral agreement by the patient tothe treatment outlined. AAHAM (Rev. 1/1/2022)Confidential and Proprietary6-1

Certified Revenue Cycle Specialist (CRCS) Exam Study Outline 2022GlossaryADC average daily census; the average number of inpatients maintainedin the hospital each day for a specific period of time.ADRR Average Days of Revenue in Accounts Receivable; also known asAccounts Receivable (AR) Days Outstanding; an estimate, using averagecurrent revenues, of the days required to turn over the accounts receivable under normal operating conditions; in simple terms, this is an estimate of the time needed to collect the accounts receivable.Advance Beneficiary Notice ABN; the Advance Beneficiary Notice ofNoncoverage; a form given to a Medicare beneficiary before services arefurnished when a service does not meet or is not expected to meet medical necessity.AHA the American Hospital Association.AHRQ Agency for Healthcare Research and Quality; one of the HHS Operating Divisions.ALOS average length of stay; a metric calculated by dividing the totalnumber of patient days by the number of discharges.APC ambulatory payment classification; a payment methodology inwhich services paid under the prospective payment system are classified into groups that are similar clinically and in terms of the resourcesthey require; a payment rate is established for each APC.APR annual percentage rate; one of the elements of disclosure requiredby the Truth in Lending Act.assignment of benefits a written authorization, signed by the policyholder (or the patient, in the absence of the policyholder) to an insurance company, to pay benefits directly to the provider; when assignment is not accepted, the payment will be sent to the patient and theprovider will have to collect it.ATB aged trial balance; a resource for internal collection efforts.ATSDR Agency for Toxic Substances and Disease Registry; one of theHHS Operating Divisions.average daily census the average number of inpatients maintained in thehospital each day for a specific period of time.average daily revenue the average amount of revenue or charges generated each day over a specified period of time.6-2 AAHAM (Rev. 1/1/2022)Confidential and Proprietary

Certified Revenue Cycle Specialist (CRCS) Exam Study Outline 2022GlossaryAverage Days of Revenue in Accounts Receivable also known as Accounts Receivable (AR) Days Outstanding; an estimate, using averagecurrent revenues, of the days required to turn over the accounts receivable under normal operating conditions; in simple terms, this is an estimate of the time needed to collect the accounts receivable.bad debt an uncollectible account resulting from the extension of credit.beneficiary a person who has healthcare insurance through Medicare.birthday rule a rule to determine coordination for benefits for a childcovered by both parents; it dictates that the parent with the first birthday in the calendar year will provide the primary coverage; if both parents happen to have the same birthday, the plan that has covered a parent longer pays first.Black Lung Benefits Act legislation that established the Federal BlackLung Program for individuals who have been diagnosed with pneumoconiosis, or black lung disease.CAH see Critical Access Hospital.capitation a method of payment in which a provider is paid a set dollaramount for each patient for a specific time period, and that payment covers all care the group of patients receives for that period, no matter theactual charges.Case Management also known as Utilization Review (UR); an area thatperforms critical tasks during registration and a patient's stay.CDC Centers for Disease Control and Prevention; one of the HHS Operating Divisions.CDM see chargemaster.Chapter 7 a type of bankruptcy applying to individuals and businessesthat cannot pay their debts based on their income; except for exemptproperty as defined by state laws, the debtor's assets are auctioned tosatisfy creditor claims; about 70% of all bankruptcy claims are filed under Chapter 7. AAHAM (Rev. 1/1/2022)Confidential and Proprietary6-3

Certified Revenue Cycle Specialist (CRCS) Exam Study Outline 2022GlossaryChapter 11 a type of bankruptcy frequently referred to as a "reorganization"; it gives a distressed business a reprieve from creditor claims whileit continues to function and works out a repayment plan.Chapter 12 a type of bankruptcy for a family farmer with "regular annualincome."Chapter 13 a type of bankruptcy designed for individuals with regularincome who desire to pay their debts, but currently are u

11240 Waples Mill Road, Suite 200, Fairfax, VA 22030 Phone: 703-281-4043 Fax: 703-359-7562 www.aaham.org . Certified Revenue Cycle Specialist