CHAM EXAM LATEST
1. obtain pre-authorization approval from insurance carriers and
payers
2. reduce unnecessary admissions and effectively manage length of
stay--Medical Necessity
3. Assist w/ Discharge process and assist with CMS regulatory
requirements
4. Acts as a liason between providers and revenue cycle department
to ensure accurate, comple documentation for compliant coding and
billing
4 major functions care management performs for revenue cycle
term?
1. review of medical necessity
2. quality of care
3. appropriateness of decision making
4. place/length of stay
what does UR's assist with?
Prospective
Concurrent
Retrospective
what are the types of utilization review?
prospective utilization review
a review of the patient proposed care plan, prior to provision or
service or entry into the facility
END OF
PAGE
1
, CHAM EXAM LATEST
concurrent utilization review
a review od the patients plan of care and resource needs real time
while patient is inpatient
retrospective utilization review
a review of services that were provided to the patient after they have
been discharged.
medical documentation
required to record pertinent facts, findings, and observations about
a persons individual health history.
late entry
if info is left out or omitted from the record, it is acceptable to go
back and amend the record. This is called what?
discharge planner
works with case management, UR, and care providers to manage
the entire patient stay and move the patient out of acute care asap
HL7 (Health Level 7)
an accredited standards developing orgs (SDO) whose realm is
clinical and administrative date
HL7 mission
END OF
PAGE
2
, CHAM EXAM LATEST
standards for interoperability that improve care delivery, optimize
workflow, reduce ambiguity and enhance knowledge transfer
among all of our stakeholders.
use of survey instruments
the most common method for orgs to access patient satisfaction
through lobby management application
how can wait times be monitored?
-continuous monitoring
-specialty bed or equipment
-foreign language interpreter
-TDD phone
determining special needs of patient
pre-admission and pre-registration
defined as the collection, dissemination, and storage of patient
demographics, financial and clinical registration info prior to the
patients arrival (24 hours in advance)
billing and reimbursement
financial management system?
lab, radiology, and nursing
patient care systems?
decision support and quality review
END OF
PAGE
3
, CHAM EXAM LATEST
administrative systems?
data integrity
an essential part of access service because errors made in reg and
admissions are transmitted to many other systems and can impact
patient care as well as the financial health of the org
minimum of 10 years
how long are medical records maintained?
patient check in
the process wherein patients check in toe begin w/the healthcare
facility or clinic using a clipboard, electronic tablet, self-service
kiosk, or another software
Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAHPS)
in 2002 who initiated a pilot program to measure patient satisfaction
levels of inpatient hospital stays?
biometric technology
to verify a patients identity, technologies may be used in form of
palm vern scanning or iris scanning using a specialized camera that
also takes a pic of the patient (stores for future visits)
1.patient tracking
2.communication
END OF
PAGE
4
1. obtain pre-authorization approval from insurance carriers and
payers
2. reduce unnecessary admissions and effectively manage length of
stay--Medical Necessity
3. Assist w/ Discharge process and assist with CMS regulatory
requirements
4. Acts as a liason between providers and revenue cycle department
to ensure accurate, comple documentation for compliant coding and
billing
4 major functions care management performs for revenue cycle
term?
1. review of medical necessity
2. quality of care
3. appropriateness of decision making
4. place/length of stay
what does UR's assist with?
Prospective
Concurrent
Retrospective
what are the types of utilization review?
prospective utilization review
a review of the patient proposed care plan, prior to provision or
service or entry into the facility
END OF
PAGE
1
, CHAM EXAM LATEST
concurrent utilization review
a review od the patients plan of care and resource needs real time
while patient is inpatient
retrospective utilization review
a review of services that were provided to the patient after they have
been discharged.
medical documentation
required to record pertinent facts, findings, and observations about
a persons individual health history.
late entry
if info is left out or omitted from the record, it is acceptable to go
back and amend the record. This is called what?
discharge planner
works with case management, UR, and care providers to manage
the entire patient stay and move the patient out of acute care asap
HL7 (Health Level 7)
an accredited standards developing orgs (SDO) whose realm is
clinical and administrative date
HL7 mission
END OF
PAGE
2
, CHAM EXAM LATEST
standards for interoperability that improve care delivery, optimize
workflow, reduce ambiguity and enhance knowledge transfer
among all of our stakeholders.
use of survey instruments
the most common method for orgs to access patient satisfaction
through lobby management application
how can wait times be monitored?
-continuous monitoring
-specialty bed or equipment
-foreign language interpreter
-TDD phone
determining special needs of patient
pre-admission and pre-registration
defined as the collection, dissemination, and storage of patient
demographics, financial and clinical registration info prior to the
patients arrival (24 hours in advance)
billing and reimbursement
financial management system?
lab, radiology, and nursing
patient care systems?
decision support and quality review
END OF
PAGE
3
, CHAM EXAM LATEST
administrative systems?
data integrity
an essential part of access service because errors made in reg and
admissions are transmitted to many other systems and can impact
patient care as well as the financial health of the org
minimum of 10 years
how long are medical records maintained?
patient check in
the process wherein patients check in toe begin w/the healthcare
facility or clinic using a clipboard, electronic tablet, self-service
kiosk, or another software
Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAHPS)
in 2002 who initiated a pilot program to measure patient satisfaction
levels of inpatient hospital stays?
biometric technology
to verify a patients identity, technologies may be used in form of
palm vern scanning or iris scanning using a specialized camera that
also takes a pic of the patient (stores for future visits)
1.patient tracking
2.communication
END OF
PAGE
4
