CHAM QUERSTIONS WITH 100 % CORRECT ANSWERS | VERIFIED

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. - Answer-Accepting Assignment The patient's ability to obtain medical care. The ease 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. - Answer-Access A number assigned to each account. This number is used to identify the account and all charges and payments received. - Answer-Account Number 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. This care is generally short-term rather than long-term or chronic care. - Answer-Acute Care A level of healthcare delivered to patients experiencing acute illness or trauma. Generally short-term (30 days). - Answer-Acute Impatient Care Patients who are scheduled for services less than 24 hours in advance of the actual service time. - Answer-Add Ons Insurance company representative. - Answer-Adjustor Costs associated with creating and submitting a bill for services, which could include: registration, utilization review, coding, billing, and collection expenses. - Answer-Administrative Costs The process of third-party payer notification of urgent/emergent inpatient admission within specified time as determined by payers (usually 24-48 hours or next business day). - Answer-Admission Authorization The first date the patient entered the hospital for a specific visit. - Answer-Admission DateWord, phrase, or International Classification of Disease (ICD10) 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. - Answer-Admitting Diagnosis 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 healthcare services. - Answer-Admitting Physician 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. Allows the beneficiary to make an informed decision prior to services regarding whether or not they wish to receive services. Are not routinely given to emergency department patients. - Answer-Advance Beneficiary Notice A written instruction relating to the provision of healthcare when a patient is incapacitated. It could include appointing someone to make medical decisions, a statement expressing the patient's wishes about anatomical gifts (i.e. organ donation) and general statements about whether or not life sustaining treatments should be withheld or withdrawn. - Answer-Advance Directive 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 number and lower deductibles. - Answer-Adverse Selection A name by which the patient is also "known as", or formerly known as. - Answer-Alias A prospective hospital claims reimbursement system currently utilized by the federal government Medicaid program and the states of New York and New Jersey. Designed to describe the complete cross section of patients seen in acute care hospitals. Approximately 639 are defined according to the principal diagnosis, secondary diagnoses, procedures, age, birth weight, sex and discharge status. Each category has an established fixed reimbursement rate based on average cost of treatment within a geographic area. 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, this system captures - Answer-All Patient Diagnosis Related Groups Assignment of Benefits (APDRG) Letters, numbers, punctuation marks and mathematical symbols, as opposed to "numeric" which is numbers only. Term typically related to the kind of data accepted in a computer field or in coding. - Answer-AlphanumericPatient receives medical or surgical care in an outpatient setting that involves a broader, less specialized range of care. Ambulatory patients are generally able to walk and are not confined to a bed. In a hospital setting, ambulatory care generally refers to healthcare services provided on an outpatient basis. - Answer-Ambulatory Care Patient A system of averaging and bundling using Current Procedural Terminology (CPT) procedure codes, Healthcare Common Procedure Coding System (HCPCS) Level II, and revenue codes submitted for payment. The ______ system utilizes groups of CPT codes based on clinical and resource similarity and establishes payment rates for each ______ grouping. The 650+ ______ are divided by significant procedures, medical services, ancillary services and partial hospitalization services. The ______ are similar clinically, by resources uses and cost. - Answer-Ambulatory Payment Classification (APC)