CHAA 2023 Study Guide Exam question and answers (C
CHAA 2023 Study Guide Exam question and answers (C
CHAA 2023 Study Guide Exam question and answers (C
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CHAA 2023 Study Guide Exam question and
answers (Certified Healthcare Access Associate
Study Guide)
A financial counselor/Financial Assistance - -In accordance with Section
501(r) regulations through the Affordable Care Act, a hospital must establish
a written financial assistance policy and make it available to patients.
-Batch Processing - -Execution of a series of jobs in a computer program
without manual intervention; it is used to help maximize the use of computer
resources and stabilize response time by performing system-intensive work
during hours when users are less likely to require access. Unlike real-time
transactions, jobs executed in batch are not available for users to view until
after the batch is run
-A Valid Physician Order - -Legibility Patient name Date (must be within
specified timeline - 30 days or as defined by state statute and/or facility
policy) Test or therapy ordered Diagnosis, signs or symptoms Physician
signature
-Patient Contact Center - -A central point in an organization from which all
customer contacts are managed, including scheduling, pre-registration, pre-
verification, prior authorization, functions, etc.
-Pricing Transparency - -In healthcare, readily available information on the
price of healthcare services that, together with other information, helps
define the value of those services and enables patients and other care
purchasers to identify, compare and choose providers that offer the desired
level of value.
-Propensity to Pay - -A means to evaluate payment risk, determine the most
appropriate collection policy and initiate financial counseling discussions.
Based on a scoring algorithm, programs can predict likelihood of payment.
Those with a history of bad debt can be adjusted or forwarded to collections
at the earliest point possible
-Access Keys - -NAHAM has developed a series of guidelines that identify
performance criteria, explain how to measure them and provide
Good/Better/Best benchmarks for facilities to measure. These are called:
-Ambulatory Payment Classifications (APCs) - -"Codes billed for outpatient
services preformed at a hospital. is calculated based on the national average
cost (operating and capital) of the hospitals"
, -Authorization - -means a determination required under a health benefits
plan, which based on the information provided, satisfies the requirements
under the member's health benefits plan for medical necessity
-Benefits for Automated Quality Assurance - -100% of registration audited,
patients access associated receive feedback on errors and can self correct,
Errors corrected earlier in the revenue cycle, and clean data before the bill
drops.
-BIRTHDAY RULE - -According to the birthday rule, the primary plan for a
child is the health plan of the parent whose birthday comes first in the
calendar year. Remember this is the date, not the year. If both birthdays fall
on the same day, then the plan that has been in effect longer is primary.
-CMS 1450 (UB-04) (UB-92) - -a federal directive requiring a hospital to
follow specific billing procedures, itemizing all services included and billed for
on each invoice. Use by hospitals, skilled nursing facilities, home health
agencies, community mental health facilities,
-Minimum Necessary Standard - -people should only access, use or disclose
the health information that is minimally necessary to accomplish a given
task or purpose.
-Coordination of benefits (COB) - -is a way of determining the order in which
benefits are paid, and the amounts that are payable, when a patient is
covered by more than one health plan.
-(HCAHPS) Hospital Consumer Assessment of Healthcare Providers - -Also
known as Hospital CAHPS, it stands for Hospital Consumer Assessment of
Healthcare Providers and Systems and is a standardized survey of hospital
patients that will capture patients' unique perspectives on hospital care for
the purpose of providing the public with comparable information on hospital
quality.
-Co-pay - -Is used by physicians and other clinicians. It is a fixed amount
that the beneficiary pays for healthcare services, regardless of the actual
charge; the amount is designated by an insurer as the patient's
responsibility.
-Critical Data Elements (CDEs) - -Commonly entered errors
-Current Procedural Terminology (CPT) - -codes, which are used for coding
procedures is used to classify services provided by physicians, hospitals and
ambulatory surgery centers
, -Exclusions - -Certain procedures are excluded from the plan. Asking the
insurance company will let you know what services are not included and
covered in the plan.
-Financial counseling/Financial investigation - -Is a method through which
the provider identifies actual payment sources and alternatives for the
patient to pay the bill
-Form locator - -is the name of the data fields on each of the uniform bills
(i.e., UB-04). The UB-04 has 81 numerically sequenced form locators, while
the 1500 has 33 form locators.
-Healthcare Common Procedure Coding Systems - -"is used to classify items
and services provided in the delivery of healthcare. Level II codes used to
classify non-physician services."
-International Classification of Diseases, Ninth Revision, Clinical
Modifications - -Was developed and implemented October 1, 2015.
Classification system includes diseases, injuries and procedures
-Lifetime Maximum - -Many payers have a calendar year and a lifetime
maximum limit on benefits paid. Once the maximum has been reached, the
benefits have been exhausted. There are no more funds available for
coverage of any further services.
-master patient index - -"Is the primary patient tracking link and therefore
considered the most important resource in a healthcare facility. It's used to
match patients being registered for care to their medical record and
minimize duplicate medical records"
-Medical necessity - -According to Medicare.gov, is defined as "healthcare
services or supplies needed to prevent, diagnose or treat an illness, injury,
condition, disease or its symptoms and that meet accepted standards of
medicine."
-Out-of-Pocket Maximum - -The total payments toward eligible expenses
that a covered person funds for him/herself and/or dependents. These
expenses may include deductibles, co-pays and coinsurance as defined by
the contract. Once this limit is reached, benefits will increase to 100 percent
for health services received during the rest of that calendar or policy year.
Deductibles may or may not be included in out-of-pocket limits.
-Patient Access Primary Role - -is to create the basis of the medical record
through the capture of specific information prior to the patient's encounter or
at the point of entry into the healthcare system.
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