NAHAM CHAM Study Guide 2017 Glossary
EXAM QUESTIONS AND ANSWERS SOLVED
AND VERIFIED CORRECTLY.
Accepting Assignment - CORRECT ANSWER✅✅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.
Access - CORRECT ANSWER✅✅The patient's ability to obtain medical care; ease of access.
Account Number - CORRECT ANSWER✅✅A number assigned to each account. This number is used to
identify the account and all charges and payments received.
Acute Care - CORRECT ANSWER✅✅Short-term medical attention given to patients with conditions of
sudden onset.
Acute Inpatient Care - CORRECT ANSWER✅✅A level of health care delivered to patients experiencing
acute
illness or trauma. Acute care is generally short-term (< 30 days).
Add-Ons - CORRECT ANSWER✅✅Patient who are scheduled for services less than 24 hours in advance
of the actual service time.
Adjustor - CORRECT ANSWER✅✅Insurance company representative.
Administrative Costs - CORRECT ANSWER✅✅Costs associated with creating and submitting a bill for
services, which could include: registration, utilization review, coding, billing, and collection expenses.
,Admission Authorization - CORRECT ANSWER✅✅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)
Admission Date - CORRECT ANSWER✅✅The first date the patient entered the hospital for a specific
visit.
Admitting Diagnosis - CORRECT ANSWER✅✅Word, phrase, or International Classification of Disease
(ICD10) code used by the admitting physician to identify the patient's condition or disease
Admitting Physician - CORRECT ANSWER✅✅The physician who writes the order for the patient to be
admitted to the hospital. This physician must have admitting privileges at the facility providing the
healthcare services.
Advance Beneficiary Notice (ABN) - CORRECT ANSWER✅✅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.
Advance Directive - CORRECT ANSWER✅✅Written instruction relating to the provision of healthcare
when a patient is incapacitated.
Adverse Selection - CORRECT ANSWER✅✅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 numbers and lower deductible plans.
Alias - CORRECT ANSWER✅✅An alias is a name by which the patient is also "known as," or formerly
known as.
All Patient Diagnosis Related Groups Assignment of Benefits (APDRG) - CORRECT ANSWER✅✅A
prospective hospital claims reimbursement system currently utilized by the federal government
Medicaid program and the states of New York and New Jersey. Approximately 639 APDRGs 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. Unlike the Diagnosis Related Group (DRG) reimbursement system,
which is intended to capture resource utilization intensity, the APDRG 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.
Alphanumeric - CORRECT ANSWER✅✅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.
Ambulatory Care Patient - CORRECT ANSWER✅✅Patient receives medical or surgical care in an
outpatient setting that involves a broader, less specialized range of care. Ambulatory patient 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.
Ambulatory Payment Classification (APC) - CORRECT ANSWER✅✅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.
System similar to Diagnosis Related Groups (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 - CORRECT ANSWER✅✅A freestanding facility, other than a physician's
office, where surgical, diagnostic, and therapeutic services are provided on an outpatient ambulatory
basis.
Ancillary Services - CORRECT ANSWER✅✅Ancillary is used to describe diagnostic or therapeutic services
performed by departments that do not have inpatient beds.
Annual Maximum Benefit Amount Deductible - CORRECT ANSWER✅✅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.
Appeal - CORRECT ANSWER✅✅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.
, Appropriate Care - CORRECT ANSWER✅✅A diagnostic or treatment measure whose expected health
benefits exceed its expected health risks by a wide enough margin to justify the measure.
Assignment of Benefit - CORRECT ANSWER✅✅Written authorization from the policyholder for their
insurance company to pay benefits directly to the care provider.
Attending Physician - CORRECT ANSWER✅✅The physician who writes outpatient orders for tests, or
supervises the patient's care during an inpatient stay.
Authorization - CORRECT ANSWER✅✅Approval obtained from an insurance carrier for a service that
represents an agreement for payment.
Authorization to Release Medical Information - CORRECT ANSWER✅✅The form authorizing to release
information from the medical records to doctors, hospitals, insurance, other agencies, etc.
Average Daily Census - CORRECT ANSWER✅✅The average number of inpatients maintained in the
hospital for each day for a specific period of time.
Average Length of Stay - CORRECT ANSWER✅✅The average number of days of service rendered to
each patient during a specific period of time.
Bad Debt - CORRECT ANSWER✅✅An accounts receivable that is regarded as uncollectible and is
charged as a credit loss even though the patient has the ability to pay
Balance Billing - CORRECT ANSWER✅✅The practice of billing a patient for the fee amount remaining
after insurer payment and co-payment have been made.
Batch Processing - CORRECT ANSWER✅✅Information technology term referring to grouping of similar
input items and then processing them together during a single machine run.
Behavioral Health - CORRECT ANSWER✅✅Assessment and treatment of mental and/or psychoactive
substance abuse disorders.
EXAM QUESTIONS AND ANSWERS SOLVED
AND VERIFIED CORRECTLY.
Accepting Assignment - CORRECT ANSWER✅✅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.
Access - CORRECT ANSWER✅✅The patient's ability to obtain medical care; ease of access.
Account Number - CORRECT ANSWER✅✅A number assigned to each account. This number is used to
identify the account and all charges and payments received.
Acute Care - CORRECT ANSWER✅✅Short-term medical attention given to patients with conditions of
sudden onset.
Acute Inpatient Care - CORRECT ANSWER✅✅A level of health care delivered to patients experiencing
acute
illness or trauma. Acute care is generally short-term (< 30 days).
Add-Ons - CORRECT ANSWER✅✅Patient who are scheduled for services less than 24 hours in advance
of the actual service time.
Adjustor - CORRECT ANSWER✅✅Insurance company representative.
Administrative Costs - CORRECT ANSWER✅✅Costs associated with creating and submitting a bill for
services, which could include: registration, utilization review, coding, billing, and collection expenses.
,Admission Authorization - CORRECT ANSWER✅✅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)
Admission Date - CORRECT ANSWER✅✅The first date the patient entered the hospital for a specific
visit.
Admitting Diagnosis - CORRECT ANSWER✅✅Word, phrase, or International Classification of Disease
(ICD10) code used by the admitting physician to identify the patient's condition or disease
Admitting Physician - CORRECT ANSWER✅✅The physician who writes the order for the patient to be
admitted to the hospital. This physician must have admitting privileges at the facility providing the
healthcare services.
Advance Beneficiary Notice (ABN) - CORRECT ANSWER✅✅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.
Advance Directive - CORRECT ANSWER✅✅Written instruction relating to the provision of healthcare
when a patient is incapacitated.
Adverse Selection - CORRECT ANSWER✅✅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 numbers and lower deductible plans.
Alias - CORRECT ANSWER✅✅An alias is a name by which the patient is also "known as," or formerly
known as.
All Patient Diagnosis Related Groups Assignment of Benefits (APDRG) - CORRECT ANSWER✅✅A
prospective hospital claims reimbursement system currently utilized by the federal government
Medicaid program and the states of New York and New Jersey. Approximately 639 APDRGs 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. Unlike the Diagnosis Related Group (DRG) reimbursement system,
which is intended to capture resource utilization intensity, the APDRG 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.
Alphanumeric - CORRECT ANSWER✅✅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.
Ambulatory Care Patient - CORRECT ANSWER✅✅Patient receives medical or surgical care in an
outpatient setting that involves a broader, less specialized range of care. Ambulatory patient 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.
Ambulatory Payment Classification (APC) - CORRECT ANSWER✅✅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.
System similar to Diagnosis Related Groups (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 - CORRECT ANSWER✅✅A freestanding facility, other than a physician's
office, where surgical, diagnostic, and therapeutic services are provided on an outpatient ambulatory
basis.
Ancillary Services - CORRECT ANSWER✅✅Ancillary is used to describe diagnostic or therapeutic services
performed by departments that do not have inpatient beds.
Annual Maximum Benefit Amount Deductible - CORRECT ANSWER✅✅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.
Appeal - CORRECT ANSWER✅✅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.
, Appropriate Care - CORRECT ANSWER✅✅A diagnostic or treatment measure whose expected health
benefits exceed its expected health risks by a wide enough margin to justify the measure.
Assignment of Benefit - CORRECT ANSWER✅✅Written authorization from the policyholder for their
insurance company to pay benefits directly to the care provider.
Attending Physician - CORRECT ANSWER✅✅The physician who writes outpatient orders for tests, or
supervises the patient's care during an inpatient stay.
Authorization - CORRECT ANSWER✅✅Approval obtained from an insurance carrier for a service that
represents an agreement for payment.
Authorization to Release Medical Information - CORRECT ANSWER✅✅The form authorizing to release
information from the medical records to doctors, hospitals, insurance, other agencies, etc.
Average Daily Census - CORRECT ANSWER✅✅The average number of inpatients maintained in the
hospital for each day for a specific period of time.
Average Length of Stay - CORRECT ANSWER✅✅The average number of days of service rendered to
each patient during a specific period of time.
Bad Debt - CORRECT ANSWER✅✅An accounts receivable that is regarded as uncollectible and is
charged as a credit loss even though the patient has the ability to pay
Balance Billing - CORRECT ANSWER✅✅The practice of billing a patient for the fee amount remaining
after insurer payment and co-payment have been made.
Batch Processing - CORRECT ANSWER✅✅Information technology term referring to grouping of similar
input items and then processing them together during a single machine run.
Behavioral Health - CORRECT ANSWER✅✅Assessment and treatment of mental and/or psychoactive
substance abuse disorders.
