CHAA CERTIFICATION EXAM WITH
CORRECT ANSWERS
Primary Care Physician (PCP) ✔️✔️physician who has the responsibility for the management
of a patient's care over time and for the coordination of episodic care with specialists; also
known as family physician or pediatrician for children. Frequently has "gatekeeper"
responsibilities as assigned by insurance companies, but is not limited to patients enrolled in a
managed care plan
Per Diem ✔️✔️a negotiated daily payment for delivery of hospital services provided;
sometimes refers only to "room and board" charges (meals, routine nursing care, etc) and may
not include ancillary services
Physician Hospital Organization (PHO) ✔️✔️an organization of physicians and hospitals that
contract with payors and other entities to provide medical care for capitated fee
Policyholder ✔️✔️subscriber of an insurance carrier also called insured
Preferred Provider Organizations (PPO) ✔️✔️these are a form of managed care health benefit
arrangements designed to provide benefits at a reasonable cost by providing its members with
incentives to use designated healthcare providers. Also covers care rendered by healthcare
providers who are not affiliated with them. However, the insured person has a significantly
greater out of pocket expense
, Prospective Payment System (PPS) ✔️✔️use of this system means that the payment to the
provider is determined in advance and based on diagnosis and procedure rather than being
retrospectively determined and based on actual charges. A fixed payment rate per DRG is set
prior to the period during which it applies. Therefore, reimbursement for patient hospitalization
has no direct relationship to the charges or costs incurred in the treatment of the patient. Updates
are published periodically in the Federal Register
Pre-admission ✔️✔️the process of creating a registration record for a future inpatient service.
Commonly known as "pre-admit". When this process refers to an outpatient, it is commonly
known as a pre-registration, although the terms may be used interchangeably
Pre-existing condition ✔️✔️medical condition for which diagnosis or treatment was received
with a fixed time period prior to enrollment in a group health. Under HIPPA that time period is
limited to 6 months
Premium ✔️✔️regularly scheduled payment for insurance coverage to Medicare, an insurance
company or a health plan
Peer Review Organization (PRO) ✔️✔️groups of practicing doctors and other healthcare
experts paid by the Federal Government to monitor and improve the care given to Medicare
patients
CORRECT ANSWERS
Primary Care Physician (PCP) ✔️✔️physician who has the responsibility for the management
of a patient's care over time and for the coordination of episodic care with specialists; also
known as family physician or pediatrician for children. Frequently has "gatekeeper"
responsibilities as assigned by insurance companies, but is not limited to patients enrolled in a
managed care plan
Per Diem ✔️✔️a negotiated daily payment for delivery of hospital services provided;
sometimes refers only to "room and board" charges (meals, routine nursing care, etc) and may
not include ancillary services
Physician Hospital Organization (PHO) ✔️✔️an organization of physicians and hospitals that
contract with payors and other entities to provide medical care for capitated fee
Policyholder ✔️✔️subscriber of an insurance carrier also called insured
Preferred Provider Organizations (PPO) ✔️✔️these are a form of managed care health benefit
arrangements designed to provide benefits at a reasonable cost by providing its members with
incentives to use designated healthcare providers. Also covers care rendered by healthcare
providers who are not affiliated with them. However, the insured person has a significantly
greater out of pocket expense
, Prospective Payment System (PPS) ✔️✔️use of this system means that the payment to the
provider is determined in advance and based on diagnosis and procedure rather than being
retrospectively determined and based on actual charges. A fixed payment rate per DRG is set
prior to the period during which it applies. Therefore, reimbursement for patient hospitalization
has no direct relationship to the charges or costs incurred in the treatment of the patient. Updates
are published periodically in the Federal Register
Pre-admission ✔️✔️the process of creating a registration record for a future inpatient service.
Commonly known as "pre-admit". When this process refers to an outpatient, it is commonly
known as a pre-registration, although the terms may be used interchangeably
Pre-existing condition ✔️✔️medical condition for which diagnosis or treatment was received
with a fixed time period prior to enrollment in a group health. Under HIPPA that time period is
limited to 6 months
Premium ✔️✔️regularly scheduled payment for insurance coverage to Medicare, an insurance
company or a health plan
Peer Review Organization (PRO) ✔️✔️groups of practicing doctors and other healthcare
experts paid by the Federal Government to monitor and improve the care given to Medicare
patients
