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Exam (elaborations)

CHAA CERTIFICATION Questions with Verified Correct Answers

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CHAA CERTIFICATION Questions with Verified Correct Answers

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CHAA CERTIFICATION Questions with
Verified Correct Answers
Admitting physician

the physician who writes the order for the patient to be admitted to the hospital. This

physician must have admitting privileges at the facility providing the healthcare services

Advanced 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

Attending physician

the physician who writes outpatient orders for tests, or supervises the patient's care during an

inpatient stay

Accepting assignment

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

Ambulatory Surgical Center

a freestanding facility, other than a physician's office, where surgical, diagnostic, and

therapeutic services are provided on an ambulatory basis

Ancillary Service

services used in the diagnosis and treatment of medical conditions. Some examples are: lab,

medical imaging, cardio-vascular services

Ambulatory Patient Classification

, a system similar to DRG to be used for outpatients. Current scheme includes 346 APC's

broken into categories of medical, diagnostic, surgical, and radiology and emergency

department and partial hospitalization services

Assignment of Benefits

written authorization from the policy holder for their insurance company to pay benefits

directly to the care provider. Normally acquired at the time of admission or registration

Authorization

approval obtained from an insurance carrier for a service that represents an agreement for

payment

Benefit Period

the way that Medicare measures the use of hospital and skilled nursing facility and ends when

the beneficiary has not received hospital or skilled nursing care for 60 days in a row. After

the 60 days have elapsed, a new one begins. The beneficiary must pay the inpatient hospital

deductible for each of these. There is no limit on the number of these

Capitation

a fixed rate of payment to cover a specified set of health services. The rate is usually provided

on a per member/ per month basis regardless of the services that are actually rendered

Clinical Data Repository (CDR)

typically an electronic storage and retrieval system for patient specific medical information

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)

this has been replaced by TRICARE

Children's Health Insurance Program (CHIPs)

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