AAHAM TEST PAPER 2025 QUESTIONS ANSD SOLUTIONS
RATED A+
✔✔assignment of benefits - ✔✔a written authorization, signed by the policyholder (or
patient, in the absence of the policyholder) to an insurance company, to pay benefits
directly tot he provider; when assignment is not accepted, the payment will be sent to
the patient and the provider will have to collect it
✔✔ATB - ✔✔aged trial balance; a resource for internal collection efforts
✔✔ATSDR - ✔✔Agency for Toxic Substances and Disease Registry; one of the DHHS
Operating Divisions
✔✔average daily census - ✔✔also known as ADC; see ADC definition
✔✔average daily revenue - ✔✔the average amount of revenue or charges generated
each day over a specified period of time
✔✔Average Days of Revenue in Accounts Receivable - ✔✔also known as Accounts
Receivable (AR) Days Outstanding; see Accounts Receivable (AR) Days Outstanding
definition
✔✔bad debt - ✔✔an uncollectible account resulting from the extension of credit
✔✔beneficiary - ✔✔a person who has healthcare insurance through Medicare
✔✔birthday rule - ✔✔a rule to determine coordination of benefits for a child covered by
both parents; it dictates that the parent with the first birthday in the calendar year will
provide the primary coverage; if both parents happen to have the same birthday, the
plan that has covered a parent longer pays first
✔✔Black Lung Benefits Act - ✔✔legislation which provides for medical treatment for
coal miners totally disabled from black lung disease
✔✔Bressers - ✔✔a cross-reference directory use in skip tracing.
✔✔brokers - ✔✔individuals who help consumers and small businesses complete the
application process and enroll in healthcare coverage through the Marketplace; they are
able to make recommendations about coverage and may only sell plans from specific
health insurance companies; see agents
✔✔CAH - ✔✔Critical Access Hospital; a non-profit hospital located in a state that has
established a Medicare Rural Hospital Flexibility Program; it must have 25 or fewer
beds and an ALOS of 96 hours of less, be located a certain minimum distance from
,other hospitals, and furnish 24-hour emergency care services; Medicare pays CAHs for
most inpatient and outpatient services on the basis of reasonable cost.
✔✔Call centers - ✔✔an option for consumers to ask questions about health coverage
options and obtain assistance with the Marketplace application process.
✔✔capitation - ✔✔a method of payment in which a provider is paid a set dollar amount
for each patient for a specific time period, and the payment covers all care the group of
patients receives for that period, no matter the actual charges.
✔✔Case Management - ✔✔also known as Utilization Review (UR); as area that
performs critical tasked during registration and a patient's stay, such as reducing
unnecessary admissions; managing the approved length of stay; ensuring an
appropriate level of care for the patient's condition; serving a liaison with the primary
and specialty physicians; serving as liaison with the insurance carrier; obtaining
approvals, when clinically necessary, for pre-certification/re-certification; advising the
patient of discharge; and assisting with appeals for denials, when applicable.
✔✔CDC - ✔✔Centers for Disease Control and Prevention; one of the DHHS Operating
Divisions
✔✔CDM - ✔✔charge description master; the charge master or master pricing list that
includes services, supplies, devices, and medication charges for the inpatient or
outpatient services by a healthcare facility.
✔✔CERT - ✔✔Comprehensive Error Rate Testing
✔✔Certified application counselors - ✔✔individuals (staff members or volunteers) who
fulfill some of the same roles as Navigators and non-Navigators; they are not
responsible for outreach and education but they do provide free information to
consumers about insurance programs, they assist them in applying for coverage, and
they help to facilitate the enrollment in health coverage
✔✔CHAMPUS - ✔✔Civilian Health and Medical Programs of the Uniformed Services;
the programs replaced by Tricare to cover healthcare for active duty and retired
members of the uniformed services, their families, and survivors.
✔✔Chapter 7 - ✔✔a type of bankruptcy applying to individuals and businesses that
cannot pay their debts based on their income; except for exempt property as defined by
state laws, the debtors assets are auctioned to satisfy creditor claims; about 70% of all
bankruptcy claim are filed under Chapter 7
✔✔Chapter 11 - ✔✔a type of bankruptcy frequently referred to as a "reorganization"; it
gives a distressed business a reprieve from creditor claims while it continues to function
and works out a repayment plan
, ✔✔Chapter 12 - ✔✔a type of bankruptcy for a family farmer with "regular annual
income."
✔✔Chapter 13 - ✔✔a type of bankruptcy designed for individuals with regular income
who desire to pay their debts, but currently are unable to do so; the debtor, under court
supervision and protection, may propose and carry out a repayment plan under which
creditors are paid over an extended period of time.
✔✔chargemaster - ✔✔also known as CDM; see CDM definition
✔✔charity care - ✔✔service provided that is never expected to result in cash flow
✔✔CHIP - ✔✔the Children's Health Insurance Program; a program for children whose
parents have too much money to be eligible for Medicaid, but not enough to buy private
insurance; it is jointly financed by the federal and state governments, and administered
by the states
✔✔CLIA - ✔✔the Clinical Laboratory Improvement Amendment of 1988; legislation
requiring all clinical laboratory services furnished to Medicare beneficiaries to the
preformed by a provider who has a CLIA certificate
✔✔Clinical Laboratory Improvement Amendment of 1988 - ✔✔also known as CLIA; see
CLIA definition
✔✔CMP - ✔✔civil monetary penalty
✔✔CMS - ✔✔Centers for Medicare and Medicaid Services; one of the DHHS Operating
Divisions
✔✔CMS 1450 - ✔✔another name for the UB-04 uniform bill form
✔✔CMS 1500 - ✔✔the billing form used to submit physician and professional service
claims to Medicare
✔✔CO - ✔✔compliance officer
✔✔COB - ✔✔coordination of benefits; the determination of which plan or insurance
policy will pay first if two health plans or insurance policies cover the same benefits
✔✔Common Working File - ✔✔a CMS file that contains Medicare patient eligibility and
utilization data
RATED A+
✔✔assignment of benefits - ✔✔a written authorization, signed by the policyholder (or
patient, in the absence of the policyholder) to an insurance company, to pay benefits
directly tot he provider; when assignment is not accepted, the payment will be sent to
the patient and the provider will have to collect it
✔✔ATB - ✔✔aged trial balance; a resource for internal collection efforts
✔✔ATSDR - ✔✔Agency for Toxic Substances and Disease Registry; one of the DHHS
Operating Divisions
✔✔average daily census - ✔✔also known as ADC; see ADC definition
✔✔average daily revenue - ✔✔the average amount of revenue or charges generated
each day over a specified period of time
✔✔Average Days of Revenue in Accounts Receivable - ✔✔also known as Accounts
Receivable (AR) Days Outstanding; see Accounts Receivable (AR) Days Outstanding
definition
✔✔bad debt - ✔✔an uncollectible account resulting from the extension of credit
✔✔beneficiary - ✔✔a person who has healthcare insurance through Medicare
✔✔birthday rule - ✔✔a rule to determine coordination of benefits for a child covered by
both parents; it dictates that the parent with the first birthday in the calendar year will
provide the primary coverage; if both parents happen to have the same birthday, the
plan that has covered a parent longer pays first
✔✔Black Lung Benefits Act - ✔✔legislation which provides for medical treatment for
coal miners totally disabled from black lung disease
✔✔Bressers - ✔✔a cross-reference directory use in skip tracing.
✔✔brokers - ✔✔individuals who help consumers and small businesses complete the
application process and enroll in healthcare coverage through the Marketplace; they are
able to make recommendations about coverage and may only sell plans from specific
health insurance companies; see agents
✔✔CAH - ✔✔Critical Access Hospital; a non-profit hospital located in a state that has
established a Medicare Rural Hospital Flexibility Program; it must have 25 or fewer
beds and an ALOS of 96 hours of less, be located a certain minimum distance from
,other hospitals, and furnish 24-hour emergency care services; Medicare pays CAHs for
most inpatient and outpatient services on the basis of reasonable cost.
✔✔Call centers - ✔✔an option for consumers to ask questions about health coverage
options and obtain assistance with the Marketplace application process.
✔✔capitation - ✔✔a method of payment in which a provider is paid a set dollar amount
for each patient for a specific time period, and the payment covers all care the group of
patients receives for that period, no matter the actual charges.
✔✔Case Management - ✔✔also known as Utilization Review (UR); as area that
performs critical tasked during registration and a patient's stay, such as reducing
unnecessary admissions; managing the approved length of stay; ensuring an
appropriate level of care for the patient's condition; serving a liaison with the primary
and specialty physicians; serving as liaison with the insurance carrier; obtaining
approvals, when clinically necessary, for pre-certification/re-certification; advising the
patient of discharge; and assisting with appeals for denials, when applicable.
✔✔CDC - ✔✔Centers for Disease Control and Prevention; one of the DHHS Operating
Divisions
✔✔CDM - ✔✔charge description master; the charge master or master pricing list that
includes services, supplies, devices, and medication charges for the inpatient or
outpatient services by a healthcare facility.
✔✔CERT - ✔✔Comprehensive Error Rate Testing
✔✔Certified application counselors - ✔✔individuals (staff members or volunteers) who
fulfill some of the same roles as Navigators and non-Navigators; they are not
responsible for outreach and education but they do provide free information to
consumers about insurance programs, they assist them in applying for coverage, and
they help to facilitate the enrollment in health coverage
✔✔CHAMPUS - ✔✔Civilian Health and Medical Programs of the Uniformed Services;
the programs replaced by Tricare to cover healthcare for active duty and retired
members of the uniformed services, their families, and survivors.
✔✔Chapter 7 - ✔✔a type of bankruptcy applying to individuals and businesses that
cannot pay their debts based on their income; except for exempt property as defined by
state laws, the debtors assets are auctioned to satisfy creditor claims; about 70% of all
bankruptcy claim are filed under Chapter 7
✔✔Chapter 11 - ✔✔a type of bankruptcy frequently referred to as a "reorganization"; it
gives a distressed business a reprieve from creditor claims while it continues to function
and works out a repayment plan
, ✔✔Chapter 12 - ✔✔a type of bankruptcy for a family farmer with "regular annual
income."
✔✔Chapter 13 - ✔✔a type of bankruptcy designed for individuals with regular income
who desire to pay their debts, but currently are unable to do so; the debtor, under court
supervision and protection, may propose and carry out a repayment plan under which
creditors are paid over an extended period of time.
✔✔chargemaster - ✔✔also known as CDM; see CDM definition
✔✔charity care - ✔✔service provided that is never expected to result in cash flow
✔✔CHIP - ✔✔the Children's Health Insurance Program; a program for children whose
parents have too much money to be eligible for Medicaid, but not enough to buy private
insurance; it is jointly financed by the federal and state governments, and administered
by the states
✔✔CLIA - ✔✔the Clinical Laboratory Improvement Amendment of 1988; legislation
requiring all clinical laboratory services furnished to Medicare beneficiaries to the
preformed by a provider who has a CLIA certificate
✔✔Clinical Laboratory Improvement Amendment of 1988 - ✔✔also known as CLIA; see
CLIA definition
✔✔CMP - ✔✔civil monetary penalty
✔✔CMS - ✔✔Centers for Medicare and Medicaid Services; one of the DHHS Operating
Divisions
✔✔CMS 1450 - ✔✔another name for the UB-04 uniform bill form
✔✔CMS 1500 - ✔✔the billing form used to submit physician and professional service
claims to Medicare
✔✔CO - ✔✔compliance officer
✔✔COB - ✔✔coordination of benefits; the determination of which plan or insurance
policy will pay first if two health plans or insurance policies cover the same benefits
✔✔Common Working File - ✔✔a CMS file that contains Medicare patient eligibility and
utilization data
