CHAA Study Guide 100% Accurate!!
Accreditation - ANSWERSDefined as "a self-assessment and external peer assessment
process used by healthcare organizations to accurately assess their level of
performance in relation to established standards and to implement ways to continuously
improve."
Examples include: TJC, Healthcare Accreditation Program, DNVGL
helps organize patient safety efforts, improves risk management, provides education,
provides professional advice, authority for Medicare certification and other third party
insurers
Quality Improvement Initiatives - ANSWERSgathering and analyzing data from patient
satisfaction surveys to initiate education and remedial action and then evaluate actions
taken.
Acute care - ANSWERSMedical 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 - ANSWERSA level of healthcare delivered to patients
experiencing acute illness or trauma. Is generally short-term (<30 days).
Advance Beneficiary Notice (ABN) - ANSWERSWritten notice issued to a fee-for-
service (Original Medicare) beneficiary before furnishing items or services that are
usually covered by Medicare but are not expected to be paid in a specific instance for
certain reasons, such as lack of medical necessity. If not given, patient cannot be billed
for service.
Advance Directive - ANSWERSAlso known as a medical directive, healthcare directive
or a living will, a legal document in which a person has outlined what they would like to
be done if they are no longer able to make decisions for themselves due to incapacity or
illness.
Ambulatory Services/Same-Day Surgery - ANSWERSPatient receives surgical
treatment and is discharged from the facility within four to six hours of procedure.
_______ can occur in an outpatient hospital department or in a freestanding ambulatory
care facility.
Ancillary Services - ANSWERSPhysician refers patients for scheduled and non-
scheduled services such as radiology, laboratory, and/or other services that are
, performed in a hospital or clinic setting. Patients leave the facility once the services are
completed.
Anti-Kickback Statute - ANSWERSAnti-fraud federal criminal statute that prohibits
offering or exchange of anything of value in exchange for healthcare business referrals,
including cash, rent, expensive hotel stays, etc.
Authorization Requirement - ANSWERSCertain services need _____ while other
procedures might not. Some insurance companies require a CPT code, so make sure
you have that available.
Batch Processing - ANSWERSExecution 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
______ are not available for users to view until after the _____ is run.
Carve Out - ANSWERSA decision to separately purchase a service, which is typically a
part of an indemnity of an HMO plan. For example, an HMO may "_________" the
behavioral health benefits and select a specialized vendor to supply these services on a
stand-alone basis. ____________ may also include medical devices that the plan pays
for in addition to the contracted per diem or case rate. Pre-certification/pre-authorization
is often required for these benefits and services.
Case Management - ANSWERSCoordination of services to help meet a patient's
healthcare needs.
Centers for Medicare and Medicaid Services (CMS) - ANSWERSFederal agency under
the Department of Health and Humans Services (HHS) that administers Medicare and
partners with state governments for administration of Medicaid and other programs,
including the Children's Health Insurance Program (CHIP).
Civilian Health and Medical Program for the Veterans Administration (CHAMPVA) -
ANSWERSThe _______ is an insurance program for the families of veterans who are
not eligible for Tricare.
Charity care - ANSWERSFree or discounted medical care provided to patients who do
not have the ability to pay for all or a part of medical costs due to limited income or
financial hardship.
Co-insurance - ANSWERSThe percentage amount that is payable, per policy
provisions, toward medical costs after the deductible has been met. For example, a
patient's _________ amount may be 20 percent, and the insurance company's
_________ could be 80 percent under a contract.
Accreditation - ANSWERSDefined as "a self-assessment and external peer assessment
process used by healthcare organizations to accurately assess their level of
performance in relation to established standards and to implement ways to continuously
improve."
Examples include: TJC, Healthcare Accreditation Program, DNVGL
helps organize patient safety efforts, improves risk management, provides education,
provides professional advice, authority for Medicare certification and other third party
insurers
Quality Improvement Initiatives - ANSWERSgathering and analyzing data from patient
satisfaction surveys to initiate education and remedial action and then evaluate actions
taken.
Acute care - ANSWERSMedical 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 - ANSWERSA level of healthcare delivered to patients
experiencing acute illness or trauma. Is generally short-term (<30 days).
Advance Beneficiary Notice (ABN) - ANSWERSWritten notice issued to a fee-for-
service (Original Medicare) beneficiary before furnishing items or services that are
usually covered by Medicare but are not expected to be paid in a specific instance for
certain reasons, such as lack of medical necessity. If not given, patient cannot be billed
for service.
Advance Directive - ANSWERSAlso known as a medical directive, healthcare directive
or a living will, a legal document in which a person has outlined what they would like to
be done if they are no longer able to make decisions for themselves due to incapacity or
illness.
Ambulatory Services/Same-Day Surgery - ANSWERSPatient receives surgical
treatment and is discharged from the facility within four to six hours of procedure.
_______ can occur in an outpatient hospital department or in a freestanding ambulatory
care facility.
Ancillary Services - ANSWERSPhysician refers patients for scheduled and non-
scheduled services such as radiology, laboratory, and/or other services that are
, performed in a hospital or clinic setting. Patients leave the facility once the services are
completed.
Anti-Kickback Statute - ANSWERSAnti-fraud federal criminal statute that prohibits
offering or exchange of anything of value in exchange for healthcare business referrals,
including cash, rent, expensive hotel stays, etc.
Authorization Requirement - ANSWERSCertain services need _____ while other
procedures might not. Some insurance companies require a CPT code, so make sure
you have that available.
Batch Processing - ANSWERSExecution 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
______ are not available for users to view until after the _____ is run.
Carve Out - ANSWERSA decision to separately purchase a service, which is typically a
part of an indemnity of an HMO plan. For example, an HMO may "_________" the
behavioral health benefits and select a specialized vendor to supply these services on a
stand-alone basis. ____________ may also include medical devices that the plan pays
for in addition to the contracted per diem or case rate. Pre-certification/pre-authorization
is often required for these benefits and services.
Case Management - ANSWERSCoordination of services to help meet a patient's
healthcare needs.
Centers for Medicare and Medicaid Services (CMS) - ANSWERSFederal agency under
the Department of Health and Humans Services (HHS) that administers Medicare and
partners with state governments for administration of Medicaid and other programs,
including the Children's Health Insurance Program (CHIP).
Civilian Health and Medical Program for the Veterans Administration (CHAMPVA) -
ANSWERSThe _______ is an insurance program for the families of veterans who are
not eligible for Tricare.
Charity care - ANSWERSFree or discounted medical care provided to patients who do
not have the ability to pay for all or a part of medical costs due to limited income or
financial hardship.
Co-insurance - ANSWERSThe percentage amount that is payable, per policy
provisions, toward medical costs after the deductible has been met. For example, a
patient's _________ amount may be 20 percent, and the insurance company's
_________ could be 80 percent under a contract.
