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CHAA 2024|2025 Study Guide With 100% Correct Answers | Verified
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CHAA 2024|2025 Study Guide With 100% Correct Answers | Verified
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CHAA 2024|2025 Study Guide With 100%Correct Answers | Verified
A financial counselor/Financial Assistance CORRECT ANSWERS 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 CORRECT ANSWERS 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 CORRECT ANSWERS 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 CORRECT ANSWERS 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 CORRECT ANSWERS 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 CORRECT ANSWERS 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 CORRECT ANSWERS 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) CORRECT ANSWERS "Codes billed for
outpatient services preformed at a hospital. is calculated based on the national average
cost (operating and capital) of the hospitals"
Authorization CORRECT ANSWERS 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 CORRECT ANSWERS 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 CORRECT ANSWERS 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) CORRECT ANSWERS 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 CORRECT ANSWERS 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) CORRECT ANSWERS 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 CORRECT
ANSWERS 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 CORRECT ANSWERS 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) CORRECT ANSWERS Commonly entered errors
Current Procedural Terminology (CPT) CORRECT ANSWERS codes, which are used
for coding procedures is used to classify services provided by physicians, hospitals and
ambulatory surgery centers
Exclusions CORRECT ANSWERS 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 CORRECT ANSWERS Is a method through
which the provider identifies actual payment sources and alternatives for the patient to
pay the bill
, Form locator CORRECT ANSWERS 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 CORRECT ANSWERS "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
CORRECT ANSWERS Was developed and implemented October 1, 2015.
Classification system includes diseases, injuries and procedures
Lifetime Maximum CORRECT ANSWERS 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 CORRECT ANSWERS "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 CORRECT ANSWERS 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 CORRECT ANSWERS 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 CORRECT ANSWERS 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: CORRECT ANSWERS Facilities are performing
in terms of data collection, timely billing, accurate reimbursement and other revenue-
cycle-related criteria.
Point-of-service (POS) collection CORRECT ANSWERS means collecting the patient's
portion of the bill at the time service is rendered.
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