CHAA 2024 STUDY GUIDE QUESTIONS
WITH ALL CORRECT ANSWERS!!
A financial counselor/Financial Assistance Answer - 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 Answer - 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 Answer - 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 Answer - 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 Answer - 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 Answer - 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 Answer - 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) Answer - "Codes billed for outpatient services preformed at a hospital. is calculated based on the national average cost (operating and capital) of the hospitals"
Authorization Answer - 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 Answer - 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 Answer - 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) Answer - 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 Answer - 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) Answer - 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 Answer - 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 Answer - 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) Answer - Commonly entered errors
Current Procedural Terminology (CPT) Answer - codes, which are used for coding procedures is used to classify services provided by physicians, hospitals and ambulatory surgery centers
Exclusions Answer - 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 Answer - Is a method through which the
provider identifies actual payment sources and alternatives for the patient to pay the bill
Form locator Answer - 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 Answer - "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 Answer - Was developed and implemented October 1, 2015. Classification system includes diseases, injuries and procedures
Lifetime Maximum Answer - 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 Answer - "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 Answer - 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 Answer - 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 Answer - 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.
Performance Standards May Include: Answer - Facilities are performing in terms of data collection, timely billing, accurate reimbursement and other revenue-cycle-
related criteria.
Point-of-service (POS) collection Answer - means collecting the patient's portion of the bill at the time service is rendered.
Valid Physician Order Answer - 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, and physician signature.
Verify the Physicians Answer - Patient Access should ________________________________ who will be treating the patient is on the panel of providers for the patient's insurance. This is especially important when a patient comes in who is unassigned (does not have a primary care physician) and will be accepted by the physician on call.
