CHAA Certification Exam with Complete Solutions

Accepting Assignment - 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 - ANSWER-The Patient's ability to obtain medical care. The ease of access 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. Account Number - ANSWER-A number assigned to each account. The number is used to identify the account and all charges and payments received. Acute Care - ANSWER-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. The care is generally short-term rather than long-term or chronic care. Acute Inpatient Care - ANSWER-A level of health care delivered to patients experiencing acute illness or trauma. Acute care is generally short-term less than 30 days. Add-Ons - ANSWER-Patients who are scheduled for services less than 24 hours in advance of the actual service time. Adjustor - ANSWER-Insurance company representative Administrative Costs - ANSWER-Costs associated with creating and submitting a bill for services, which could include, registration, utilization review, coding, billing, and collection expenses. Admission Authorization - ANSWER-The process of third party payor notification of urgent/emergent inpatient admission within specified time as determined by payors which is usually within a 24 to 48 hour or next business day. Admission Date - ANSWER-The first date the patient entered the hospital for a specific visit. Admitting Diagnosis - ANSWER-Word, phrase, International Classification of Disease (ICD9) 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. Admitting Physician - ANSWER-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 health care services. Advance Beneficiary Notice (ABN) - 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. The advanced beneficiary notice (ABN) allows the beneficiary to make a informed decision prior to services whether or not he/she wishes to receive services. ABNs are not routinely given to emergency department patients. Advanced Directives - ANSWER-An advance directive is a written instruction relating to the provision of health care when a patient is incapacitated. It could include appointing someone to make medical decisions, a state expressing the patients wishes about anatomical gifts (like organ donation), and general statements about whether or not life-sustaining treatments should be withheld or withdrawn. Adverse Selection - 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 - 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) - ANSWER-A prospective hospital claims reimbursement system currently utilized by the federal government Medicaid program and the states of New York and New Jersey. APDRGs were designed to describe the complete cross section of patients seen in acute care hospitals. Approximately 639 APDRGs are defined according to the principal diagnosis, secondary diagnoses, procedures, age, birth weight, sex, discharge status. Each category has an established fixed reimbursement rate based on average cost of treatment within a geographic area. APRDRG's 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, the APRDRG 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. Alphanumeric - ANSWER-Letter, 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 - ANSWER-Patient receives medical or surgical care in a 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 health care services provided on an outpatient basis. Ambulatory Payment Classification - 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. The APC system utilizes groups 142 of CPT codes based on clinical and resource similarity and establishes payment rates for each APC grouping. The 650 plus APCs are divided by significant procedures, medical services, ancillary services and partial hospitalization services. The APCs are similar clinically, by resources used and cost. A payment rate has been established for each APC. System similar to Diagnosis Related Group's (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.