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CHAA 2024 STUDY GUIDE QUESTIONS WITH CORRECT ANSWERS.
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CHAA 2024 STUDY GUIDE QUESTIONS WITH CORRECT ANSWERS.
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CHAA 2024 STUDY GUIDE QUESTIONSWITH CORRECT ANSWERS
A financial counselor/Financial Assistance - Correct Answer - In accordance with Section
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501(r) regulations through the Affordable Care Act, a hospital must establish a written
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financial assistance policy and make it available to patients.
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Batch Processing - Correct Answer - Execution of a series of jobs in a computer program
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without manual intervention; it is used to help maximize the use of computer resources and
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stabilize response time by performing system-intensive work during hours when users are
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less likely to require access. Unlike real-time transactions, jobs executed in batch are not
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available for users to view until after the batch is run
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A Valid Physician Order - Correct Answer - Legibility Patient name Date (must be within
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specified timeline - 30 days or as defined by state statute and/or facility policy) Test or
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therapy ordered Diagnosis, signs or symptoms Physician signature
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Patient Contact Center - Correct Answer - A central point in an organization from which all
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customer contacts are managed, including scheduling, pre-registration, pre-verification,
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prior authorization, functions, etc.
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Pricing Transparency - Correct Answer - In healthcare, readily available information on the
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price of healthcare services that, together with other information, helps define the value of
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those services and enables patients and other care purchasers to identify, compare and
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choose providers that offer the desired level of value.
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Propensity to Pay - Correct Answer - A means to evaluate payment risk, determine the
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most appropriate collection policy and initiate financial counseling discussions. Based on
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a scoring algorithm, programs can predict likelihood of payment. Those with a history of
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bad debt can be adjusted or forwarded to collections at the earliest point possible
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Access Keys - Correct Answer - NAHAM has developed a series of guidelines that identify
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performance criteria, explain how to measure them and provide Good/Better/Best
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benchmarks for facilities to measure. These are called:
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Ambulatory Payment Classifications (APCs) - Correct Answer - "Codes billed for
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outpatient services preformed at a hospital. is calculated based on the national average
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cost (operating and capital) of the hospitals"
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Authorization - Correct Answer - means a determination required under a health benefits
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plan, which based on the information provided, satisfies the requirements under the
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member's health benefits plan for medical necessity
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,Benefits for Automated Quality Assurance - Correct Answer - 100% of registration audited,
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patients access associated receive feedback on errors and can self correct, Errors
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corrected earlier in the revenue cycle, and clean data before the bill drops.
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BIRTHDAY RULE - Correct Answer - According to the birthday rule, the primary plan for a
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child is the health plan of the parent whose birthday comes first in the calendar year.
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Remember this is the date, not the year. If both birthdays fall on the same day, then the
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plan that has been in effect longer is primary.
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CMS 1450 (UB-04) (UB-92) - Correct Answer - a federal directive requiring a hospital to
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follow specific billing procedures, itemizing all services included and billed for on each
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invoice. Use by hospitals, skilled nursing facilities, home health agencies, community
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mental health facilities,
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Minimum Necessary Standard - Correct Answer - people should only access, use or
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disclose the health information that is minimally necessary to accomplish a given task or
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purpose.
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Coordination of benefits (COB) - Correct Answer - is a way of determining the order in t t t t t t t t t t t t t t t
which benefits are paid, and the amounts that are payable, when a patient is covered by
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more than one health plan.
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(HCAHPS) Hospital Consumer Assessment of Healthcare Providers - Correct Answer -
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Also known as Hospital CAHPS, it stands for Hospital Consumer Assessment of
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Healthcare Providers and Systems and is a standardized survey of hospital patients that
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will capture patients' unique perspectives on hospital care for the purpose of providing the
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public with comparable information on hospital quality.
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Co-pay - Correct Answer - Is used by physicians and other clinicians. It is a fixed amount
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that the beneficiary pays for healthcare services, regardless of the actual charge; the
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amount is designated by an insurer as the patient's responsibility.
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Critical Data Elements (CDEs) - Correct Answer - Commonly entered errors
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Current Procedural Terminology (CPT) - Correct Answer - codes, which are used for
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coding procedures is used to classify services provided by physicians, hospitals and
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ambulatory surgery centers
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Exclusions - Correct Answer - Certain procedures are excluded from the plan. Asking the
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insurance company will let you know what services are not included and covered in the
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plan.
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Financial counseling/Financial investigation - Correct Answer - Is a method through which
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the provider identifies actual payment sources and alternatives for the patient to pay the
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bill
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, Form locator - Correct Answer - is the name of the data fields on each of the uniform bills
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(i.e., UB-04). The UB-04 has 81 numerically sequenced form locators, while the 1500 has
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33 form locators.
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Healthcare Common Procedure Coding Systems - Correct Answer - "is used to classify
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items and services provided in the delivery of healthcare. Level II codes used to classify
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non-physician services."
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International Classification of Diseases, Ninth Revision, Clinical Modifications - Correct
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Answer - Was developed and implemented October 1, 2015. Classification system
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includes diseases, injuries and procedures
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Lifetime Maximum - Correct Answer - Many payers have a calendar year and a lifetime
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maximum limit on benefits paid. Once the maximum has been reached, the benefits have
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been exhausted. There are no more funds available for coverage of any further services.
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master patient index - Correct Answer - "Is the primary patient tracking link and therefore
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considered the most important resource in a healthcare facility. It's used to match patients
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being registered for care to their medical record and minimize duplicate medical records"
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Medical necessity - Correct Answer - According to Medicare.gov, is defined as "healthcare
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services or supplies needed to prevent, diagnose or treat an illness, injury, condition,
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disease or its symptoms and that meet accepted standards of medicine."
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Out-of-Pocket Maximum - Correct Answer - The total payments toward eligible expenses t t t t t t t t t t t
that a covered person funds for him/herself and/or dependents. These expenses may
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include deductibles, co-pays and coinsurance as defined by the contract. Once this limit is
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reached, benefits will increase to 100 percent for health services received during the rest
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of that calendar or policy year. Deductibles may or may not be included in out-of-pocket
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limits.
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Patient Access Primary Role - Correct Answer - is to create the basis of the medical record
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through the capture of specific information prior to the patient's encounter or at the point of
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entry into the healthcare system.
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Performance Standards May Include: - Correct Answer - Facilities are performing in terms
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of data collection, timely billing, accurate reimbursement and other revenue-cycle-related
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criteria.
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Point-of-service (POS) collection - Correct Answer - means collecting the patient's portion t t t t t t t t t t t
of the bill at the time service is rendered.
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Valid Physician Order - Correct Answer - Legibility, patient name, date (must be within
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specified timeline-30 days or as defined by state statute and or facility policy.), test or
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therapy ordered, diagnosis, signs or symptoms, and physician signature.
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