AAHAM EXAMS SET 2025 QUESTIONS ANSD SOLUTIONS
RATED A+
✔✔Commission on Office Laboratory Accreditation - ✔✔COLA; one of six CMS-
approved accreditation organizations
✔✔complex review - ✔✔a RAC review involving review of the medical record
documentation; used where there is a high probability that the service is not covered or
where no Medicare policy, Medicare article, or Medicare-sanctioned coding guideline
exists
✔✔Comprehensive Error Rate Testing - ✔✔CERT; a program instituted by CMS to
monitor and calculate the accuracy and error rates for all MACs and to monitor the
accuracy of Medicare payments to FIs, carriers and DMERCs
✔✔COP - ✔✔Medicare Conditions of Participation
✔✔Corporate Integrity Agreement - ✔✔the agreement that spells out integrity measures
required of a provider that has engaged in serious misconduct but is being allowed to
continue participating in the healthcare programs
✔✔COW - ✔✔Certificate of Waiver; the CLIA certificate issued to a laboratory that
performs only waived tests -"simple laboratory examinations and procedures that have
an insignificant risk of an erroneous result"
✔✔CPG - ✔✔Compliance Program Guidance
✔✔demand letter - ✔✔document describing the rationale for a RAC determination and
providing information in case an appeal is warranted
✔✔DOJ - ✔✔Department of Justice
✔✔EHR - ✔✔electronic health record
✔✔EMC - ✔✔emergency medical condition
✔✔Emergency Medical Treatment and Active Labor Act - ✔✔EMTALA; the Act that
requires hospitals with emergency departments to provide a medical screening
examination to any individual who comes to the emergency department and requests
such an examination, and prohibits hospitals with emergency departments from refusing
to examine or treat individuals with an emergency medical condition; also known as the
Federal Anit- Dumping Statute
✔✔EMR - ✔✔electronic medical record
,✔✔EMTALA - ✔✔Emergency Medical Treatment and Active Labor Act
✔✔EPHI - ✔✔electronic protected health information
✔✔Fair Credit Billing Act - ✔✔an amendment to the Truth in Lending Act that protects
consumers from inaccurate or unfair practices by issuers of open-ended credit
✔✔Fair Credit Reporting Act - ✔✔Title VI of the Consumer Credit Protection Act that
defines what information from consumer reports can be used, by whom, and when
✔✔Fair Debt Collection Practices Act - ✔✔Title VIII of the Consumer Credit Protection
Act that protects consumers from abusive, deceptive, and unfair collection practices
✔✔False Claims Act - ✔✔the Act that helps recover billions of dollars stolen through
fraud while also protecting whistleblowers from retaliation
✔✔FDA - ✔✔Food and Drug Administration
✔✔Federal Anti-Dumping Statute - ✔✔another name for EMTALA
✔✔Fraud - ✔✔willingly and knowingly violating regulations
✔✔full denial - ✔✔a RAC denial that occurs when the RAC determines that the service
was not reasonable or necessary or that the service billed to CMS was not rendered
✔✔GAO - ✔✔General Accounting Office; one of two government entities that produces
reports every year that review and analyze aspects of Medicare payments
✔✔GME - ✔✔Graduate Medical Education
✔✔HCFAC - ✔✔Health Care Fraud and Abuse Control program established by HIPAA
to combat waste, fraud, and abuse in the Medicare and Medicaid programs
✔✔HCQIP - ✔✔Health Care Quality Improvement Program; a program that supports
the mission of CMS to assure healthcare security for beneficiaries
✔✔Health Care Fraud and Abuse Control - ✔✔HCFAC; a program established by
HIPAA to combat waste, fraud, and abuse in the Medicare and Medicaid programs
✔✔Health Care Quality Improvement Program - ✔✔HCQIP; a program that supports
the mission of CMS to assure healthcare security for beneficiaries
, ✔✔Health Information Technology for Economic and Clinical Health - ✔✔HITECH; an
Act intended to accelerate the adoption of EHRs/EMRs among providers
✔✔Health Insurance Portability and Accountability Act - ✔✔HIPAA; an Act passed in
1996 to improve portability and continuity of health insurance coverage; to combat
waste, fraud and abuse in health insurance and healthcare delivery; to promote the use
of medical savings accounts; to improve access to long-term care services and
coverage; to simplify the administration of health insurance, etc.
✔✔HHS - ✔✔Department of Health and Human Services
✔✔HIPAA - ✔✔Health Insurance Portability and Accountability Act
✔✔HITECH - ✔✔Health Information Technology for Economic and Clinical Health Act;
an Act intended to accelerate the adoption of EHRs/EMRs among providers
✔✔hospital - ✔✔an institution primarily engaged in providing inpatient diagnostic and
therapeutic services, outpatient, or rehabilitation services
✔✔Hospital Payment Monitoring Program - ✔✔HPMP; a program responsible for
monitoring payments to inpatient acute care hospitals
✔✔ICD - ✔✔International Classification of Diseases
✔✔IME - ✔✔Indirect Medical Education
✔✔IOM - ✔✔Institute of Medicine
✔✔JCAHO - ✔✔Joint Commission on Accreditation of Healthcare Organizations; former
name for the Joint Commission- TJC
✔✔Joint Commission on Accreditation of Healthcare Organizations - ✔✔JCAHO; former
name for the Joint Commission -TJC
✔✔Judicial Review - ✔✔the fifth level of appeal, which can be done if the denial issue is
still in controversy following the Appeals Council's decision
✔✔MAC - ✔✔Medicare Administrative Contractor
✔✔Medicaid Fraud Control Unit - ✔✔federal-and state- funded law enforcement entities
that investigate and prosecute provider fraud and violations of state law pertaining to
fraud in the Medicaid program; they also review complaints of resident abuse or neglect
in nursing homes and other health care facilities
RATED A+
✔✔Commission on Office Laboratory Accreditation - ✔✔COLA; one of six CMS-
approved accreditation organizations
✔✔complex review - ✔✔a RAC review involving review of the medical record
documentation; used where there is a high probability that the service is not covered or
where no Medicare policy, Medicare article, or Medicare-sanctioned coding guideline
exists
✔✔Comprehensive Error Rate Testing - ✔✔CERT; a program instituted by CMS to
monitor and calculate the accuracy and error rates for all MACs and to monitor the
accuracy of Medicare payments to FIs, carriers and DMERCs
✔✔COP - ✔✔Medicare Conditions of Participation
✔✔Corporate Integrity Agreement - ✔✔the agreement that spells out integrity measures
required of a provider that has engaged in serious misconduct but is being allowed to
continue participating in the healthcare programs
✔✔COW - ✔✔Certificate of Waiver; the CLIA certificate issued to a laboratory that
performs only waived tests -"simple laboratory examinations and procedures that have
an insignificant risk of an erroneous result"
✔✔CPG - ✔✔Compliance Program Guidance
✔✔demand letter - ✔✔document describing the rationale for a RAC determination and
providing information in case an appeal is warranted
✔✔DOJ - ✔✔Department of Justice
✔✔EHR - ✔✔electronic health record
✔✔EMC - ✔✔emergency medical condition
✔✔Emergency Medical Treatment and Active Labor Act - ✔✔EMTALA; the Act that
requires hospitals with emergency departments to provide a medical screening
examination to any individual who comes to the emergency department and requests
such an examination, and prohibits hospitals with emergency departments from refusing
to examine or treat individuals with an emergency medical condition; also known as the
Federal Anit- Dumping Statute
✔✔EMR - ✔✔electronic medical record
,✔✔EMTALA - ✔✔Emergency Medical Treatment and Active Labor Act
✔✔EPHI - ✔✔electronic protected health information
✔✔Fair Credit Billing Act - ✔✔an amendment to the Truth in Lending Act that protects
consumers from inaccurate or unfair practices by issuers of open-ended credit
✔✔Fair Credit Reporting Act - ✔✔Title VI of the Consumer Credit Protection Act that
defines what information from consumer reports can be used, by whom, and when
✔✔Fair Debt Collection Practices Act - ✔✔Title VIII of the Consumer Credit Protection
Act that protects consumers from abusive, deceptive, and unfair collection practices
✔✔False Claims Act - ✔✔the Act that helps recover billions of dollars stolen through
fraud while also protecting whistleblowers from retaliation
✔✔FDA - ✔✔Food and Drug Administration
✔✔Federal Anti-Dumping Statute - ✔✔another name for EMTALA
✔✔Fraud - ✔✔willingly and knowingly violating regulations
✔✔full denial - ✔✔a RAC denial that occurs when the RAC determines that the service
was not reasonable or necessary or that the service billed to CMS was not rendered
✔✔GAO - ✔✔General Accounting Office; one of two government entities that produces
reports every year that review and analyze aspects of Medicare payments
✔✔GME - ✔✔Graduate Medical Education
✔✔HCFAC - ✔✔Health Care Fraud and Abuse Control program established by HIPAA
to combat waste, fraud, and abuse in the Medicare and Medicaid programs
✔✔HCQIP - ✔✔Health Care Quality Improvement Program; a program that supports
the mission of CMS to assure healthcare security for beneficiaries
✔✔Health Care Fraud and Abuse Control - ✔✔HCFAC; a program established by
HIPAA to combat waste, fraud, and abuse in the Medicare and Medicaid programs
✔✔Health Care Quality Improvement Program - ✔✔HCQIP; a program that supports
the mission of CMS to assure healthcare security for beneficiaries
, ✔✔Health Information Technology for Economic and Clinical Health - ✔✔HITECH; an
Act intended to accelerate the adoption of EHRs/EMRs among providers
✔✔Health Insurance Portability and Accountability Act - ✔✔HIPAA; an Act passed in
1996 to improve portability and continuity of health insurance coverage; to combat
waste, fraud and abuse in health insurance and healthcare delivery; to promote the use
of medical savings accounts; to improve access to long-term care services and
coverage; to simplify the administration of health insurance, etc.
✔✔HHS - ✔✔Department of Health and Human Services
✔✔HIPAA - ✔✔Health Insurance Portability and Accountability Act
✔✔HITECH - ✔✔Health Information Technology for Economic and Clinical Health Act;
an Act intended to accelerate the adoption of EHRs/EMRs among providers
✔✔hospital - ✔✔an institution primarily engaged in providing inpatient diagnostic and
therapeutic services, outpatient, or rehabilitation services
✔✔Hospital Payment Monitoring Program - ✔✔HPMP; a program responsible for
monitoring payments to inpatient acute care hospitals
✔✔ICD - ✔✔International Classification of Diseases
✔✔IME - ✔✔Indirect Medical Education
✔✔IOM - ✔✔Institute of Medicine
✔✔JCAHO - ✔✔Joint Commission on Accreditation of Healthcare Organizations; former
name for the Joint Commission- TJC
✔✔Joint Commission on Accreditation of Healthcare Organizations - ✔✔JCAHO; former
name for the Joint Commission -TJC
✔✔Judicial Review - ✔✔the fifth level of appeal, which can be done if the denial issue is
still in controversy following the Appeals Council's decision
✔✔MAC - ✔✔Medicare Administrative Contractor
✔✔Medicaid Fraud Control Unit - ✔✔federal-and state- funded law enforcement entities
that investigate and prosecute provider fraud and violations of state law pertaining to
fraud in the Medicaid program; they also review complaints of resident abuse or neglect
in nursing homes and other health care facilities
