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CHAA Certification Exam/38 Questions and Answers
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CHAA Certification Exam/38 Questions andAnswers
Accepting Assignment - -When a provider agrees to accept the allowable
charges as the full fee and cannot charge the patient the difference between
the insurance payment and the provider's normal fee.
-Access - -The Patient's ability to obtain medical care. The ease of access is
determined by such components as the availability of medical services and
their acceptability to the patient, the location of health care facilities,
transportation, hours of operation and cost of care.
-Account Number - -A number assigned to each account. The number is
used to identify the account and all charges and payments received.
-Acute Care - -Medical attention given to patients with conditions of sudden
onset that demand urgent attention or care of limited duration when the
patient's health and wellness would deteriorate without treatment. The care
is generally short-term rather than long-term or chronic care.
-Acute Inpatient Care - -A level of health care delivered to patients
experiencing acute illness or trauma. Acute care is generally short-term less
than 30 days.
-Add-Ons - -Patients who are scheduled for services less than 24 hours in
advance of the actual service time.
-Adjustor - -Insurance company representative
-Administrative Costs - -Costs associated with creating and submitting a bill
for services, which could include, registration, utilization review, coding,
billing, and collection expenses.
-Admission Authorization - -The process of third party payor notification of
urgent/emergent inpatient admission within specified time as determined by
payors which is usually within a 24 to 48 hour or next business day.
-Admission Date - -The first date the patient entered the hospital for a
specific visit.
-Admitting Diagnosis - -Word, phrase, International Classification of Disease
(ICD9) code used by the admitting physician to identify a condition or
disease from which a patient suffers and for which the patient needs or
seeks medical care.
, -Admitting Physician - -The physician who writes the order for the patient to
be admitted to the hospital. The physician must have admitting privileges at
the facility providing the health care services.
-Advance Beneficiary Notice (ABN) - -A notice that a care provider should
give a Medicare beneficiary to sign if the services being provided may not be
considered medically necessary and Medicare may not pay for them. The
advanced beneficiary notice (ABN) allows the beneficiary to make a informed
decision prior to services whether or not he/she wishes to receive services.
ABNs are not routinely given to emergency department patients.
-Advanced Directives - -An advance directive is a written instruction relating
to the provision of health care when a patient is incapacitated. It could
include appointing someone to make medical decisions, a state expressing
the patients wishes about anatomical gifts (like organ donation), and general
statements about whether or not life-sustaining treatments should be
withheld or withdrawn.
-Adverse Selection - -Among applicants for a given group or individual
program, the tendency for those with an impaired health status, or who are
prone to higher than average utilization of benefits to be enrolled in
disproportionate numbers and lower deductible plans.
-Alias - -An alias is a name by which the patient is also known as or formerly
known as.
-All patient Diagnosis Related Groups Assignment of Benefits (APDRG) - -A
prospective hospital claims reimbursement system currently utilized by the
federal government Medicaid program and the states of New York and New
Jersey. APDRGs were designed to describe the complete cross section of
patients seen in acute care hospitals. Approximately 639 APDRGs are
defined according to the principal diagnosis, secondary diagnoses,
procedures, age, birth weight, sex, discharge status. Each category has an
established fixed reimbursement rate based on average cost of treatment
within a geographic area. APRDRG's were developed to quantify the
difference in demographic
groups and clinical risk factors for patients treated in hospitals. This
proprietary grouping system's (i.e. 3M) purpose is to obtain fair and accurate
statistical comparisons between disparate populations and groups. Unlike
the Diagnosis Related Group (DRG) reimbursement system which is intended
to capture
resource utilization intensity, the APRDRG system captures and relates the
Severity of Illness and Risk of Mortality factors present as a result of a
patient's disease and disorders and the interaction of those disorders. A form
is signed by the Patient giving the healthcare provider authority to bill
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