CHAA 2024 Study Guide with Complete
Solutions
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 Exec...
CHAA 2024 Study Guide with Complete Solutions 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 facil ity 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 purc hasers 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 scorin g 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 criteri a, 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 natio nal 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 be en 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 h ealth 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 k nown 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 publi c 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 cen ters 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.
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