CHAM
Study online at https://quizlet.com/_i20c4q
1. Accepting Assignment: When a provider agrees to accept the allowable charges as the full fee and cannot
charge the patient the difference between the insurance payment and the provider's normal fee.
2. Access: The patient's ability to obtain medical care. The ease is determined by such components as the availability
of medical services and their acceptability to the patient, the location of health-care facilities, transportation, hours of
operation and cost of care.
3. Account Number: A number assigned to each account. This number is used to identify the account and all
charges and payments received.
4. Acute Care: Medical 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. This care is
generally short-term rather than long-term or chronic care.
5. Acute Impatient Care: A level of healthcare delivered to patients experiencing acute illness or trauma.
Generally short-term (<30 days).
6. Add Ons: Patients who are scheduled for services less than 24 hours in advance of the actual service time.
7. Adjustor: Insurance company representative.
8. Administrative Costs: Costs associated with creating and submitting a bill for services, which could include:
registration, utilization review, coding, billing, and collection expenses.
9. Admission Authorization: The process of third-party payer notification of urgent/emergent inpatient
admission within specified time as determined by payers (usually 24-48 hours or next business day).
10. Admission Date: The first date the patient entered the hospital for a specific visit.
11. Admitting Diagnosis: Word, phrase, or International Classification of Disease (ICD10) code used by the
admitting physician to identify a condition or disease from which a patient suffers and for which the patient needs or
seeks medical care.
12. Admitting Physician: The physician who writes the order for the patient to be admitted to the hospital.
The physician must have admitting privileges at the facility providing the healthcare services.
13. Advance Beneficiary Notice: A notice that a care provider should give a Medicare beneficiary to sign
if the services being provided may not be considered medically necessary and Medicare may not pay for them. Allows
the beneficiary to make an informed decision prior to services regarding whether or not they wish to receive services.
Are not routinely given to emergency department patients.
14. Advance Directive: A written instruction relating to the provision of healthcare when a patient is incapac-
itated. It could include appointing someone to make medical decisions, a statement expressing the patient's wishes
about anatomical gifts (i.e. organ donation) and general statements about whether or not life sustaining treatments
should be withheld or withdrawn.
, CHAM
Study online at https://quizlet.com/_i20c4q
15. Adverse Selection: Among applicants for a given group or individual program, the tendency for those
with an impaired health status, or who are prone to higher than average utilization of benefits to be enrolled in
disproportionate number and lower deductibles.
16. Alias: A name by which the patient is also "known as", or formerly known as.
17. All Patient Diagnosis Related Groups Assignment of Benefits (APDRG): A
prospective hospital claims reimbursement system currently utilized by the federal government Medicaid program and
the states of New York and New Jersey. Designed to describe the complete cross section of patients seen in acute care
hospitals. Approximately 639 are defined according to the principal diagnosis, secondary diagnoses, procedures, age,
birth weight, sex and discharge status. Each category has an established fixed reimbursement rate based on average
cost of treatment within a geographic area. Were developed to quantify the difference in demographic groups and
clinical risk factors for patients treated in hospitals. This proprietary grouping system's (i.e. 3M) purpose is to obtain
fair and accurate statistical comparisons between disparate populations and groups. Unlike the Diagnosis Related
Group (DRG) reimbursement system, which is intended to capture resource utilization intensity, this system captures
and relates the severity of illness and risk of mortality factors present as a result of a patient's disease and disorders
and the interaction of those disorders. A form is signed by the patient giving the healthcare provider authority to bill
his/her insurance plan and receive payment. The form is generally presented and signed at the time of registration.
18. Alphanumeric: Letters, numbers, punctuation marks and mathematical symbols, as opposed to "numeric"
which is numbers only. Term typically related to the kind of data accepted in a computer field or in coding.
19. Ambulatory Care Patient: Patient receives medical or surgical care in an outpatient setting that involves
a broader, less specialized range of care. Ambulatory patients are generally able to walk and are not confined to a bed.
In a hospital setting, ambulatory care generally refers to healthcare services provided on an outpatient basis.
20. Ambulatory Payment Classification (APC): 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 ______ system utilizes groups of CPT codes based on clinical and
resource similarity and establishes payment rates for each ______ grouping. The 650+ ______ are divided by significant
procedures, medical services, ancillary services and partial hospitalization services. The ______ are similar clinically, by
resources uses and cost.
21. Ambulatory Surgical Center: A freestanding facility, other than a physician's office, where surgical,
diagnostic, and therapeutic services are provided on an outpatient ambulatory basis.
22. Ancillary Services: A unit of the hospital, other than a nursing unit, that provides medical services such as
diagnostic testing and therapeutic procedures, or dispenses medical products, such as medications or medical/surgica
supplies. Examples: Laboratory, Medical Imaging, Physical Therapy and Pharmacy. Ancillary is used to describe diag-
, CHAM
Study online at https://quizlet.com/_i20c4q
nostic or therapeutic services, such as laboratory, radiology, pharmacy, or physical therapy, performed by departments
that do not have inpatient beds.
23. 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, that the third party payer designates as the patient/guar-
antors responsibility. Usually the deductible must be paid before the benefits will be paid by the payer.
24. Appeal: A special kind of complaint made when a beneficiary or provider disagrees with decisions about
healthcare services-typically related to payment issues. There is usually a special process used to appeal payer decisions.
25. 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.
26. Assignment of Benefit: Written authorization from the policyholder for their insurance company to pay
benefits directly to the care provider. Normally acquired at the time of admission or registration.
27. Attending Physician: The physician who writes outpatient orders for tests, or supervises the patient's care
during an inpatient stay.
28. Authorization: Approval obtained from an insurance carrier for a service that represents an agreement for
payment.
29. Authorization to Release Medical Information: The form authorizing to release information
from the medical records to doctors, hospitals, insurance, other agencies, etc.
30. Average Daily Census (ADC): The average number of inpatients maintained in the hospital for each
day for a specific period of time.
31. Average Length of Stay: The average number of days of service rendered to each patient during a
specific period of time.
32. Bad Debt: An accounts receivable that is regarded as uncollectible and is charged as a credit loss even though
the patient has the ability to pay.
33. Balance Billing: The practice of billing a patient for the fee amount remaining after insurer payment and
co-payment have been made.
34. Batch Processing: Information technology term referring to grouping of similar input items and then
processing them together during a single machine run.
35. Behavioral Health: Assessment and treatment of mental and/or psychoactive substance abuse disorders.
Study online at https://quizlet.com/_i20c4q
1. Accepting Assignment: When a provider agrees to accept the allowable charges as the full fee and cannot
charge the patient the difference between the insurance payment and the provider's normal fee.
2. Access: The patient's ability to obtain medical care. The ease is determined by such components as the availability
of medical services and their acceptability to the patient, the location of health-care facilities, transportation, hours of
operation and cost of care.
3. Account Number: A number assigned to each account. This number is used to identify the account and all
charges and payments received.
4. Acute Care: Medical 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. This care is
generally short-term rather than long-term or chronic care.
5. Acute Impatient Care: A level of healthcare delivered to patients experiencing acute illness or trauma.
Generally short-term (<30 days).
6. Add Ons: Patients who are scheduled for services less than 24 hours in advance of the actual service time.
7. Adjustor: Insurance company representative.
8. Administrative Costs: Costs associated with creating and submitting a bill for services, which could include:
registration, utilization review, coding, billing, and collection expenses.
9. Admission Authorization: The process of third-party payer notification of urgent/emergent inpatient
admission within specified time as determined by payers (usually 24-48 hours or next business day).
10. Admission Date: The first date the patient entered the hospital for a specific visit.
11. Admitting Diagnosis: Word, phrase, or International Classification of Disease (ICD10) code used by the
admitting physician to identify a condition or disease from which a patient suffers and for which the patient needs or
seeks medical care.
12. Admitting Physician: The physician who writes the order for the patient to be admitted to the hospital.
The physician must have admitting privileges at the facility providing the healthcare services.
13. Advance Beneficiary Notice: A notice that a care provider should give a Medicare beneficiary to sign
if the services being provided may not be considered medically necessary and Medicare may not pay for them. Allows
the beneficiary to make an informed decision prior to services regarding whether or not they wish to receive services.
Are not routinely given to emergency department patients.
14. Advance Directive: A written instruction relating to the provision of healthcare when a patient is incapac-
itated. It could include appointing someone to make medical decisions, a statement expressing the patient's wishes
about anatomical gifts (i.e. organ donation) and general statements about whether or not life sustaining treatments
should be withheld or withdrawn.
, CHAM
Study online at https://quizlet.com/_i20c4q
15. Adverse Selection: Among applicants for a given group or individual program, the tendency for those
with an impaired health status, or who are prone to higher than average utilization of benefits to be enrolled in
disproportionate number and lower deductibles.
16. Alias: A name by which the patient is also "known as", or formerly known as.
17. All Patient Diagnosis Related Groups Assignment of Benefits (APDRG): A
prospective hospital claims reimbursement system currently utilized by the federal government Medicaid program and
the states of New York and New Jersey. Designed to describe the complete cross section of patients seen in acute care
hospitals. Approximately 639 are defined according to the principal diagnosis, secondary diagnoses, procedures, age,
birth weight, sex and discharge status. Each category has an established fixed reimbursement rate based on average
cost of treatment within a geographic area. Were developed to quantify the difference in demographic groups and
clinical risk factors for patients treated in hospitals. This proprietary grouping system's (i.e. 3M) purpose is to obtain
fair and accurate statistical comparisons between disparate populations and groups. Unlike the Diagnosis Related
Group (DRG) reimbursement system, which is intended to capture resource utilization intensity, this system captures
and relates the severity of illness and risk of mortality factors present as a result of a patient's disease and disorders
and the interaction of those disorders. A form is signed by the patient giving the healthcare provider authority to bill
his/her insurance plan and receive payment. The form is generally presented and signed at the time of registration.
18. Alphanumeric: Letters, numbers, punctuation marks and mathematical symbols, as opposed to "numeric"
which is numbers only. Term typically related to the kind of data accepted in a computer field or in coding.
19. Ambulatory Care Patient: Patient receives medical or surgical care in an outpatient setting that involves
a broader, less specialized range of care. Ambulatory patients are generally able to walk and are not confined to a bed.
In a hospital setting, ambulatory care generally refers to healthcare services provided on an outpatient basis.
20. Ambulatory Payment Classification (APC): 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 ______ system utilizes groups of CPT codes based on clinical and
resource similarity and establishes payment rates for each ______ grouping. The 650+ ______ are divided by significant
procedures, medical services, ancillary services and partial hospitalization services. The ______ are similar clinically, by
resources uses and cost.
21. Ambulatory Surgical Center: A freestanding facility, other than a physician's office, where surgical,
diagnostic, and therapeutic services are provided on an outpatient ambulatory basis.
22. Ancillary Services: A unit of the hospital, other than a nursing unit, that provides medical services such as
diagnostic testing and therapeutic procedures, or dispenses medical products, such as medications or medical/surgica
supplies. Examples: Laboratory, Medical Imaging, Physical Therapy and Pharmacy. Ancillary is used to describe diag-
, CHAM
Study online at https://quizlet.com/_i20c4q
nostic or therapeutic services, such as laboratory, radiology, pharmacy, or physical therapy, performed by departments
that do not have inpatient beds.
23. 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, that the third party payer designates as the patient/guar-
antors responsibility. Usually the deductible must be paid before the benefits will be paid by the payer.
24. Appeal: A special kind of complaint made when a beneficiary or provider disagrees with decisions about
healthcare services-typically related to payment issues. There is usually a special process used to appeal payer decisions.
25. 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.
26. Assignment of Benefit: Written authorization from the policyholder for their insurance company to pay
benefits directly to the care provider. Normally acquired at the time of admission or registration.
27. Attending Physician: The physician who writes outpatient orders for tests, or supervises the patient's care
during an inpatient stay.
28. Authorization: Approval obtained from an insurance carrier for a service that represents an agreement for
payment.
29. Authorization to Release Medical Information: The form authorizing to release information
from the medical records to doctors, hospitals, insurance, other agencies, etc.
30. Average Daily Census (ADC): The average number of inpatients maintained in the hospital for each
day for a specific period of time.
31. Average Length of Stay: The average number of days of service rendered to each patient during a
specific period of time.
32. Bad Debt: An accounts receivable that is regarded as uncollectible and is charged as a credit loss even though
the patient has the ability to pay.
33. Balance Billing: The practice of billing a patient for the fee amount remaining after insurer payment and
co-payment have been made.
34. Batch Processing: Information technology term referring to grouping of similar input items and then
processing them together during a single machine run.
35. Behavioral Health: Assessment and treatment of mental and/or psychoactive substance abuse disorders.
