CHAA Certification Questions and Answers
100% Solved
Ambulatory Payment Classification 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 APC system utilizes groups
142 of CPT codes based on clinical and resource similarity and establishes payment rates for
each APC grouping. The 650 plus APCs are divided by significant procedures, medical services,
ancillary services and partial hospitalization services. The APCs
are similar clinically, by resources used and cost. A payment rate has been established for each
APC. System similar to Diagnosis Related Group's (DRG) to be used for outpatients. Current
scheme includes 346 APCs broken into categories of Medical, Diagnostic, Surgical, and
Radiology and include Emergency Department and partial hospitalization services.
Ambulatory Surgical Center A freestanding facility, other than a physician office, where
surgical, diagnostic, and therapeutic services are provided on an outpatient ambulatory basis.
Ancillary Services A unit of the hospital, other than a nursing unit, which provides a
medical services such as a diagnostic testing, therapeutic procedures, or dispense medical
products, such as medications or medical/surgical supplies. Examples, laboratory, Medical
imaging, physical therapy, pharmacy. Ancillary is used to describe diagnostic or therapeutic
, services, such as, laboratory, radiology, pharmacy, or physical therapy, performed by departments
that do not have inpatient beds
Annual Maximum Benefit Amount Deductible The maximum dollar amount set by a
Managed Care Organization (MCO) that limits the total amount the plan must pay for all health
care services provided to a subscriber in a year. A deductible is the set amount, per benefit year
or period, the
third party payor designates as the patient/guarantor's responsibility. Usually the deductible must
be paid before benefits will be paid by the payor. The maximum dollar amount set by an MCO
that limits the total amount the plan must pay for all health care services provided to a subscriber
in a year.
Appeal An appeal is a special kind of complaint made when a beneficiary or provider
disagrees with decisions about health care services typically related to payment issues. There is
usually a special process used to appeal a payor decisions.
Appropriate Care A diagnostic or treatment measure whose expected health benefits
exceed its expected health risks by a wide enough margin to justify the measure.
100% Solved
Ambulatory Payment Classification 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 APC system utilizes groups
142 of CPT codes based on clinical and resource similarity and establishes payment rates for
each APC grouping. The 650 plus APCs are divided by significant procedures, medical services,
ancillary services and partial hospitalization services. The APCs
are similar clinically, by resources used and cost. A payment rate has been established for each
APC. System similar to Diagnosis Related Group's (DRG) to be used for outpatients. Current
scheme includes 346 APCs broken into categories of Medical, Diagnostic, Surgical, and
Radiology and include Emergency Department and partial hospitalization services.
Ambulatory Surgical Center A freestanding facility, other than a physician office, where
surgical, diagnostic, and therapeutic services are provided on an outpatient ambulatory basis.
Ancillary Services A unit of the hospital, other than a nursing unit, which provides a
medical services such as a diagnostic testing, therapeutic procedures, or dispense medical
products, such as medications or medical/surgical supplies. Examples, laboratory, Medical
imaging, physical therapy, pharmacy. Ancillary is used to describe diagnostic or therapeutic
, services, such as, laboratory, radiology, pharmacy, or physical therapy, performed by departments
that do not have inpatient beds
Annual Maximum Benefit Amount Deductible The maximum dollar amount set by a
Managed Care Organization (MCO) that limits the total amount the plan must pay for all health
care services provided to a subscriber in a year. A deductible is the set amount, per benefit year
or period, the
third party payor designates as the patient/guarantor's responsibility. Usually the deductible must
be paid before benefits will be paid by the payor. The maximum dollar amount set by an MCO
that limits the total amount the plan must pay for all health care services provided to a subscriber
in a year.
Appeal An appeal is a special kind of complaint made when a beneficiary or provider
disagrees with decisions about health care services typically related to payment issues. There is
usually a special process used to appeal a payor decisions.
Appropriate Care A diagnostic or treatment measure whose expected health benefits
exceed its expected health risks by a wide enough margin to justify the measure.
