CHAA ACTUAL FINALS QUESTIONS AND ANSWERS
SET A+
✔✔Patient Contact Center - ✔✔A central point in an organization from which all
customer contacts are managed, including scheduling, pre-registration, pre-verification,
prior authorization, functions, etc.
✔✔Patient Experience - ✔✔The outcome of interactions between an organization and a
customer as perceived through the customer's conscious and subconscious mind. It is
especially important in determining HCAHPS reimbursement.
"The sum of all interactions, shaped by an organization's culture, that influence patient
perceptions across the continuum of care."
-The Beryl Institute
✔✔Patient Placement - ✔✔Includes a request for a bed (inpatient, outpatient,
observation, etc.). It involves the collection and documentation of the information
necessary to determine that the requirements for the requested level of service are met.
✔✔Patient Portal - ✔✔Secure online website that gives patients convenient 24-hour
access to personal health information from anywhere with an internet connection. Some
portals allow for viewing recent hospital visits or the ability for a patient to self-schedule
certain tests to be performed at the hospital.
✔✔Patient Satisfaction - ✔✔In evaluations of healthcare quality, patient satisfaction is a
performance indicator measured in a self-report study and a specific type of customer
satisfaction metric.
✔✔Personally identifiable information (PII) - ✔✔Any type of information that can be
used to identify a person such as name, Social Security number and medical record
numbers.
,✔✔Power of attorney - ✔✔Type of living will; this document authorizes a specific person
to make decisions on their behalf when they have become incapacitated.
✔✔Pre-certification/Pre-authorization - ✔✔Certain insurance companies require pre-
certification or pre-authorization from the Primary Care Physician (PCP) prior to
services being performed.
✔✔Presumptive Eligibility - ✔✔Hospitals and qualified physicians have the option of
screening patients to see if they qualify for Medicaid. Based on the patient's self-
attested answers to specific questions, they may be granted this temporary coverage
but must complete the application process in order to keep the coverage.
✔✔Pricing Transparency - ✔✔In healthcare, readily available information on the price of
healthcare services that, together with other information, helps define the value of those
services and enables patients and other care purchasers to identify, compare and
choose providers that offer the desired level of value.
✔✔Propensity to Pay - ✔✔A means to evaluate payment risk, determine the most
appropriate collection policy and initiate financial counseling discussions. Based on a
scoring algorithm, programs can predict likelihood of payment. Those with a history of
bad debt can be adjusted or forwarded to collections at the earliest point possible.
✔✔Protected health information (PHI) - ✔✔Any protected health information (PHI), as
identified under HIPAA, that is produced, saved, received or transferred.
✔✔Recovery - ✔✔Process of restoring data that has been accidently lost, corrupted or
made unavailable, typically from an external storage system used for back-up.
✔✔Recurring Services - ✔✔Physical therapy, occupational therapy, speech therapy,
cardiac rehabilitation or pulmonary rehabilitation that occurs over time based on a
clinician's order and evaluation by the clinical staff before and during the course of care.
✔✔Respite Care - ✔✔Short-term care provided at home, in a long-term care facility, at
a community based center, or in a hospital when another setting is not available.
Respite care allows families caring for elders or other mentally or physically dependent
family members time off in their care-giving responsibilities. This type of care is not
reimbursable through Medicare or Medicaid.
✔✔Restricted Disclosure - ✔✔Defined in the HITECH Omnibus of 2013, a patient's right
to restrict PHI disclosure.
✔✔Server - ✔✔A central computer dedicated to sending and receiving data from other
computers on a network.
,✔✔Specialty Clinics - ✔✔A patient is seen for specialized medical or surgical services
and is discharged following treatment or care. This could be for a series of recurring
visits based on the duration of care according to the physician's order.
✔✔Telephone Consumer Protection Act (TCPA): - ✔✔A federal law regulating the use
of prerecorded messages and auto-dialers; safeguards consumer privacy by restricting
unwanted telemarketing communications.
✔✔The Joint Commission (TJC) - ✔✔An independent, not-for-profit organization that
evaluates and accredits more than 21,000 healthcare organizations in the United
States.
✔✔The Patient Protection and Affordable Care Act of 2010 (PPACA) - ✔✔The
Affordable Care Act (ACA), or "Obamacare," included reforms to affordability, quality
and availability. It aimed to greatly increase the amount of Americans who have access
to affordable health insurance; provided assistance for those with pre-existing
conditions; extended dependent coverage up to age 26; required coverage of
preventative services and immunizations; eliminated lifetime limits on benefits; and
expanded Medicaid coverage to more low-income Americans.
✔✔The Stark Law - ✔✔A group of several federal laws that prohibit physician self-
referral.
✔✔TRICARE - ✔✔A healthcare program for military active, reservists, and retirees and
families. Active-duty service members are automatically enrolled in TRICARE. Retirees
and their dependents can enroll in TRICARE but may have to pay for the cost of
coverage.
-Tricare is secondary to all other insurance plans, except Medicaid
-Tricare is not considered a group health plan
✔✔Unbundling - ✔✔Fraudulent practice of breaking down services currently bundled
together in one CPT code into individual codes for the purpose of higher
reimbursement.
✔✔Upcoding - ✔✔Process of assigning an inaccurate billing code for a medical
procedure or treatment to increase reimbursement, considered to be a fraudulent billing
practice.
✔✔Verification of Physician - ✔✔Be sure to verify that the physician who will be treating
the patient is on the panel of providers for the patient's insurance. This is especially
important when a patient comes in who is unassigned (does not have a primary care
physician) and will be accepted by the physician on call.
, ✔✔Veterans Administration (VA) - ✔✔Largest integrated healthcare system in America
serving veterans who served in the active military for at least 24 continuous months and
were discharged or released under any condition other than dishonorable (some
exceptions exist).
✔✔Veterans Choice Program - ✔✔Program where the VA enrolled member is
authorized to receive care from community-based providers.
Care is authorized when their local VA health care facility is unable to provide services
due to:
-Medical care at the VA is not available for at least 30 days or extended wait times for
appointments
-Lack of available specialists in the area
-Patient lives more than 40 miles from a VA medical care facility
-When traveling creates excessive travel burdens
✔✔Office of the Inspector General (OIG) - ✔✔Is a division of the US Department of
Health and Human Services (HHS). It is the OIG's responsibility to protect the integrity
of HHS programs and the well-being of beneficiaries by detecting and preventing fraud,
waste and abuse; improve program efficiency and effectiveness; and holding
accountable those who do not meet program requirements or violate the federal
healthcare law. The two major programs under HHS are Medicare and Medicaid.
The OIG is also responsible for educating the public about fraudulent schemes so they
can protect themselves and know how to report suspicious activities. Some of the more
common fraud laws include: The Stark Law, the Anti-Kickback Statute and the False
Claims Act.
✔✔Purpose of a Compliance Program - ✔✔The OIG states that "compliance is a
dynamic process that helps to ensure that hospitals and other healthcare providers are
better able to fulfill their commitment to ethical behavior, as well as meet the changes
and challenges being imposed upon them by Congress and private insurers." With the
establishment of a voluntary compliance program and a designated hospital compliance
officer, hospitals will be able improve the quality of patient care, substantially reduce
fraud, waste and abuse, and reduce the cost of healthcare to federal, state and private
health insurers.
✔✔Elements of a Compliance Program include: - ✔✔I. Establish compliance standards,
procedures and policies
II. Assign oversight responsibility for compliance to an individual high in the
organization's structure (i.e., dedicated compliance officer and a compliance committee)
III. Screening and evaluation of employees, physicians, vendors
IV. Communication, education and training on compliance issues
V. Monitoring, auditing and the establishment of internal reporting systems (e.g.,
anonymous hotlines, email, etc.)
VI. Discipline for non-compliance
VII. Respond appropriately and immediately to detected offenses
SET A+
✔✔Patient Contact Center - ✔✔A central point in an organization from which all
customer contacts are managed, including scheduling, pre-registration, pre-verification,
prior authorization, functions, etc.
✔✔Patient Experience - ✔✔The outcome of interactions between an organization and a
customer as perceived through the customer's conscious and subconscious mind. It is
especially important in determining HCAHPS reimbursement.
"The sum of all interactions, shaped by an organization's culture, that influence patient
perceptions across the continuum of care."
-The Beryl Institute
✔✔Patient Placement - ✔✔Includes a request for a bed (inpatient, outpatient,
observation, etc.). It involves the collection and documentation of the information
necessary to determine that the requirements for the requested level of service are met.
✔✔Patient Portal - ✔✔Secure online website that gives patients convenient 24-hour
access to personal health information from anywhere with an internet connection. Some
portals allow for viewing recent hospital visits or the ability for a patient to self-schedule
certain tests to be performed at the hospital.
✔✔Patient Satisfaction - ✔✔In evaluations of healthcare quality, patient satisfaction is a
performance indicator measured in a self-report study and a specific type of customer
satisfaction metric.
✔✔Personally identifiable information (PII) - ✔✔Any type of information that can be
used to identify a person such as name, Social Security number and medical record
numbers.
,✔✔Power of attorney - ✔✔Type of living will; this document authorizes a specific person
to make decisions on their behalf when they have become incapacitated.
✔✔Pre-certification/Pre-authorization - ✔✔Certain insurance companies require pre-
certification or pre-authorization from the Primary Care Physician (PCP) prior to
services being performed.
✔✔Presumptive Eligibility - ✔✔Hospitals and qualified physicians have the option of
screening patients to see if they qualify for Medicaid. Based on the patient's self-
attested answers to specific questions, they may be granted this temporary coverage
but must complete the application process in order to keep the coverage.
✔✔Pricing Transparency - ✔✔In healthcare, readily available information on the price of
healthcare services that, together with other information, helps define the value of those
services and enables patients and other care purchasers to identify, compare and
choose providers that offer the desired level of value.
✔✔Propensity to Pay - ✔✔A means to evaluate payment risk, determine the most
appropriate collection policy and initiate financial counseling discussions. Based on a
scoring algorithm, programs can predict likelihood of payment. Those with a history of
bad debt can be adjusted or forwarded to collections at the earliest point possible.
✔✔Protected health information (PHI) - ✔✔Any protected health information (PHI), as
identified under HIPAA, that is produced, saved, received or transferred.
✔✔Recovery - ✔✔Process of restoring data that has been accidently lost, corrupted or
made unavailable, typically from an external storage system used for back-up.
✔✔Recurring Services - ✔✔Physical therapy, occupational therapy, speech therapy,
cardiac rehabilitation or pulmonary rehabilitation that occurs over time based on a
clinician's order and evaluation by the clinical staff before and during the course of care.
✔✔Respite Care - ✔✔Short-term care provided at home, in a long-term care facility, at
a community based center, or in a hospital when another setting is not available.
Respite care allows families caring for elders or other mentally or physically dependent
family members time off in their care-giving responsibilities. This type of care is not
reimbursable through Medicare or Medicaid.
✔✔Restricted Disclosure - ✔✔Defined in the HITECH Omnibus of 2013, a patient's right
to restrict PHI disclosure.
✔✔Server - ✔✔A central computer dedicated to sending and receiving data from other
computers on a network.
,✔✔Specialty Clinics - ✔✔A patient is seen for specialized medical or surgical services
and is discharged following treatment or care. This could be for a series of recurring
visits based on the duration of care according to the physician's order.
✔✔Telephone Consumer Protection Act (TCPA): - ✔✔A federal law regulating the use
of prerecorded messages and auto-dialers; safeguards consumer privacy by restricting
unwanted telemarketing communications.
✔✔The Joint Commission (TJC) - ✔✔An independent, not-for-profit organization that
evaluates and accredits more than 21,000 healthcare organizations in the United
States.
✔✔The Patient Protection and Affordable Care Act of 2010 (PPACA) - ✔✔The
Affordable Care Act (ACA), or "Obamacare," included reforms to affordability, quality
and availability. It aimed to greatly increase the amount of Americans who have access
to affordable health insurance; provided assistance for those with pre-existing
conditions; extended dependent coverage up to age 26; required coverage of
preventative services and immunizations; eliminated lifetime limits on benefits; and
expanded Medicaid coverage to more low-income Americans.
✔✔The Stark Law - ✔✔A group of several federal laws that prohibit physician self-
referral.
✔✔TRICARE - ✔✔A healthcare program for military active, reservists, and retirees and
families. Active-duty service members are automatically enrolled in TRICARE. Retirees
and their dependents can enroll in TRICARE but may have to pay for the cost of
coverage.
-Tricare is secondary to all other insurance plans, except Medicaid
-Tricare is not considered a group health plan
✔✔Unbundling - ✔✔Fraudulent practice of breaking down services currently bundled
together in one CPT code into individual codes for the purpose of higher
reimbursement.
✔✔Upcoding - ✔✔Process of assigning an inaccurate billing code for a medical
procedure or treatment to increase reimbursement, considered to be a fraudulent billing
practice.
✔✔Verification of Physician - ✔✔Be sure to verify that the physician who will be treating
the patient is on the panel of providers for the patient's insurance. This is especially
important when a patient comes in who is unassigned (does not have a primary care
physician) and will be accepted by the physician on call.
, ✔✔Veterans Administration (VA) - ✔✔Largest integrated healthcare system in America
serving veterans who served in the active military for at least 24 continuous months and
were discharged or released under any condition other than dishonorable (some
exceptions exist).
✔✔Veterans Choice Program - ✔✔Program where the VA enrolled member is
authorized to receive care from community-based providers.
Care is authorized when their local VA health care facility is unable to provide services
due to:
-Medical care at the VA is not available for at least 30 days or extended wait times for
appointments
-Lack of available specialists in the area
-Patient lives more than 40 miles from a VA medical care facility
-When traveling creates excessive travel burdens
✔✔Office of the Inspector General (OIG) - ✔✔Is a division of the US Department of
Health and Human Services (HHS). It is the OIG's responsibility to protect the integrity
of HHS programs and the well-being of beneficiaries by detecting and preventing fraud,
waste and abuse; improve program efficiency and effectiveness; and holding
accountable those who do not meet program requirements or violate the federal
healthcare law. The two major programs under HHS are Medicare and Medicaid.
The OIG is also responsible for educating the public about fraudulent schemes so they
can protect themselves and know how to report suspicious activities. Some of the more
common fraud laws include: The Stark Law, the Anti-Kickback Statute and the False
Claims Act.
✔✔Purpose of a Compliance Program - ✔✔The OIG states that "compliance is a
dynamic process that helps to ensure that hospitals and other healthcare providers are
better able to fulfill their commitment to ethical behavior, as well as meet the changes
and challenges being imposed upon them by Congress and private insurers." With the
establishment of a voluntary compliance program and a designated hospital compliance
officer, hospitals will be able improve the quality of patient care, substantially reduce
fraud, waste and abuse, and reduce the cost of healthcare to federal, state and private
health insurers.
✔✔Elements of a Compliance Program include: - ✔✔I. Establish compliance standards,
procedures and policies
II. Assign oversight responsibility for compliance to an individual high in the
organization's structure (i.e., dedicated compliance officer and a compliance committee)
III. Screening and evaluation of employees, physicians, vendors
IV. Communication, education and training on compliance issues
V. Monitoring, auditing and the establishment of internal reporting systems (e.g.,
anonymous hotlines, email, etc.)
VI. Discipline for non-compliance
VII. Respond appropriately and immediately to detected offenses
