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CHAA 2024 STUDY GUIDE WITH COMPLETE SOLUTION
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CHAA 2024 STUDY GUIDE WITH COMPLETE SOLUTION
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CHAA 2024 STUDY GUIDE WITH COMPLETE SOLUTIONA 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
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