CRHC flashcards
CRHC · Build recall with a focused review session.
32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- All-Inclusive Rate (AIR)
- A single bundled payment per qualifying RHC visit that covers all services and supplies furnished during the visit, adjusted annually by the Medicare Economic Index.
- Qualifying Visit
- A face-to-face encounter with an RHC practitioner (physician, NP, PA, CNM, etc.) that is medically necessary and results in a billable service.
- RHC Certification
- Medicare approval granted after a survey determines the clinic meets the Conditions for Coverage in 42 CFR Part 491.
- Health Professional Shortage Area
- A geographic area or population group designated by HRSA as having a shortage of primary care, dental, or mental health professionals.
- QAPI Program
- A formal quality assessment and performance improvement program required for RHCs that includes measuring, analyzing, and improving clinical and administrative processes.
- Cost Report
- An annual financial report (Form CMS-222-92) filed by RHCs to report allowable costs and statistics used to determine Medicare reimbursement.
- 60-Day Rule
- A requirement that providers report and return Medicare and Medicaid overpayments within 60 days of identifying them, or face potential False Claims Act liability.
- OIG Exclusion List
- A database of individuals and entities prohibited from participating in federal healthcare programs; RHCs must screen employees and contractors against it.
- Telehealth RHC
- The provision of RHC services via telecommunications technology; Medicare reimburses these services at the same rate as in-person visits when criteria are met.
- Care Coordination
- The deliberate organization of patient care activities and information sharing among providers to facilitate appropriate, high-quality care.
- Governing Body
- The entity with ultimate authority and responsibility for the RHC's operations, compliance, and quality of care.
- Credentialing
- The process of verifying and evaluating a practitioner's qualifications, licensure, and experience for the purpose of granting clinical privileges.
- Plan of Correction
- A written plan submitted by an RHC in response to survey deficiencies, detailing corrective actions and timelines for completion.
- State Survey Agency
- The state entity that conducts certification surveys on behalf of CMS to determine whether an RHC meets Medicare requirements.
- MEI
- Medicare Economic Index; an index used to update RHC payment limits annually to account for inflation in input prices.
- Coinsurance
- The portion of the RHC all-inclusive rate that the beneficiary is responsible for paying, typically 20% after meeting the deductible.
- HPSA Designation
- A designation by HRSA indicating a shortage of primary care providers, which can qualify an RHC for enhanced reimbursement or eligibility.
- Conditions for Coverage
- The federal requirements (42 CFR Part 491) that an RHC must meet to be certified for Medicare participation.
- Infection Control Program
- A required RHC program to prevent and control infections, including hand hygiene, sterilization, and isolation protocols, following accepted standards.
- Medication Reconciliation
- The process of comparing a patient's medication orders to all of the medications they have been taking to avoid errors and duplications.
- Compliance Program
- A set of internal policies and procedures to prevent and detect violations of law, including a compliance officer, training, and auditing.
- Stark Law
- A federal law prohibiting physician self-referral for certain designated health services reimbursed by Medicare or Medicaid, unless an exception applies.
- Revenue Cycle
- The financial process from patient registration through final payment, including coding, billing, and collections.
- Days in A/R
- A key revenue cycle metric calculated as (total accounts receivable / total charges) × days in period, indicating how quickly claims are paid.
- MIPS
- Merit-based Incentive Payment System; a Medicare quality reporting program that adjusts payments based on quality, cost, and improvement activities.
- Population Health
- The health outcomes of a group of individuals, including the distribution of outcomes within the group, managed through preventive and chronic care.
- Organizational Chart
- A diagram showing the structure of the RHC, including lines of authority, reporting relationships, and roles.
- Privileging
- The process by which the governing body grants a practitioner permission to perform specific clinical procedures based on verified competency.
- Mock Survey
- A simulated certification survey conducted internally to identify and correct deficiencies before an official survey.
- CMS-222-92
- The Medicare cost report form used by RHCs to report allowable costs and statistics for reimbursement determination.
- Face-to-Face Encounter
- A direct in-person interaction between an RHC practitioner and a patient that is required for a visit to qualify for Medicare payment.
- After-Hours Coverage
- The requirement that RHCs have arrangements for patients to receive services when the clinic is closed, often through an on-call provider or agreement.