AAHAM CCAT EXAM Questions & Answers 100% Correct

APC - Answer ambulatory payment classification; a payment methodology in which services paid under the prospective payment system are classified into groups that are similar clincially and in terms of the resources they require; a payment rate is est. for each APC APR - Answer annual percentage rate; one of the elements of disclosure required by the Truth in lending act ASSIGNMENT OF BENEFITS - Answer a written authorization, signed by the policyholder(or the patient, in the absence of the policyholder) to an insurance company, to pay benefits directly to the provider; when assigment is not accepted, the payment will be sent to the patient and the provider will have to collect it. ATB - Answer aged trial balance; a resource for internal collection efforts. A T S D R - Answer Agency for Toxic Substances and Disease Registry; one of the DHHS Operating Divisions Average Daily Census - Answer The average number of inpatients maintained in the hospital each day for a specific period ot time. Average Days of Revenue in Accounts Receivable - Answer also knos as Accounts Receivable (AR) Days Outstanding; an estimate, using average current revenues, of the days required to turn over the account rec. under normal operating coditions; in simple terms, this is an estimate of the time needed to collect the accts. rec. Bad Debt - Answer an uncollectible account resulting from the extension of credit Beneficiary - Answer A person who has healthcare insurance through Medicare. Birthday Rule - Answer A rule to determine coordination for benefits for a child covered by both parents; it dictates that the parent with the first birthday in the calendar year will provide the primary coverage; if both parents happen to have the same birthday; the plan that has covered a parent longer pays first. Black Lung Benefits Act - Answer legislation which provides for medical treatment for coal mines totally disabled from black lung disease. Bressers - Answer a cross-reference directory used in skip tracing. CAH Critical Access Hospital - Answer critical access hospital a non profit hospital located in a state that has established a medicare Rural Hospital Flexibility Program; it must have 25 or fewer beds and an ALOS of 96 hr or less, be located a certain minimum distance from other hospitals, and furnish 24 hour emergency care services; Medicare pays CAHs for most inpatient and outpatient services on the basis of reasonable cost capitation - Answer a method of payment in which a provider is paid a set dollar amount for each patient for a specific time period, and that payment covers all care the group of patients receives for that period, no matter the actual charges. Case Management UR Review - Answer also known as utilization review (UR) an area that performs critical tasks during registration and a patient's stay, such as reducing unnecessary admissions, managing the approved LOS; ensuring an appropriate level of care for the patients condition; serving as a liaison with the primary and spec phys; serving as a liaison with the ins. carrier; obtaining approvals, when clinically necessary, for pre-certification; recert; advising the patient of dischare; and assisting with appeals for denials, when applicable CDC - Answer Centers for Diseas Control and Prevention; one of the DHHS Operating Divisions CDM - Answer charge description master; the chargemaster or master pricing list that includes services, supplies, devices, and medication charges for inpatient or outpatient services by a healthcare facility. CERT - Answer Comprehensive Error Rate Testing CHAMPUS - Answer Civilian Health and Medical Programs of the Uniformed Services; the programs replaced by TRICARE to cover healthcare for active duty and retired members of the uniformed services, their families, and survivors. Chapter 7 - Answer a type of bankruptcy applying to individuals and businesses that cannot pay their debts based on their income; except for exempty property as defined by state laws, the debtor's assets are auctioned to satisy creditor claims; about 70% of all bankrupcy claims are filed under Chapter 7 Chapter 11 - Answer a type of bankrupcy frequently referred to as a "reorganization" it gives a distressed busiiness a reprieve from creditor claims while it continues to function and works out a repayment plan. Chapter 12 - Answer a type of bankruptcy for a family farmer with "regular annual income". Chapter 13 - Answer a type of bankruptcy designed for individuals with regular income who desire to pay their debts, but currently are unable to do so; the debtor, under court supervision and protection, may propose and carry out a repayment plan under which creditors are paid over an extended period of time. chargemaster - Answer also known as charge description master (CDM); the master pricing list that includes services, supplies, devices, and medication charges for inpatient or outpatient services by a healthcare facility. charity care - Answer service provided that is never expected to result in cash flow. CLIA - Answer the Clinical Laboratory Improvement Amendment of 1988; legislation requiring all clinical laboratory services furnished to Medicare beneficiaries to be performed by a provider who has CLIA certificate. CMP - Answer civil monetary penalty. CMS - Answer Centers for Medicare and Medicaid Services; one of the DHHS Operating Divisions. CMS 1450 - Answer another name for the UB-04 uniform bill form. CMS 1500 - Answer the billing form used to submit physician and professional service claims to Medicare. CO - Answer Compliance Officer COB - Answer coordination of benefits; the determindation of which plan or insurance policy will pay first if two health plans or insurance policies cover the same benefits. Common Working File (C W F) - Answer a CMS file that contains Medicare patient eligibility and utilization data. conditional payment - Answer a payment made when antoher payer is responsible, but the claim is not expected to be paid promptly (usually within 120 days from receipt of the claim); it prevents the beneficiary from having to pay out of pocket; Medicare then hasx the right to recover any payments that should have been made by another payer. Consumer Credit Protection Act - Answer The first general federal consumer protection legislation; its provisions include the Truth in Lending Act, the Fair Credit Billing Act, the Fair Credit Reporting Act, and the Fair Debt Collection Practices Act. Courtesy discharge - Answer a type of discharge in which a patient's financial considerations have been met so he or she is allowed to leave the hospital without going thru the usual formalities, the patient is billed at a later date. CPT - Answer Current Procedural Terminology; a system of descriptive terms and five-digit numeric codes that are used primarily to identify medical services and procedures furnished by physicians and other healthcare professionals. CPU - Answer Central processing unit. C R A - Answer credit reporting agency. custodial care - Answer care that is primarily for the purpose of meeting personal needs; person without professional training may provide custodial care; it is not covered by Medicare data mailer - Answer a system-generated, free form statement that is used to communicate the status of a patient's account and/or to bill the patient for unpaid amount remaining on the account. DHHS - Answer Department of Health and Human Services; the US government's principal agency for protecting the health of all Americans and providing essential human services; it is also the federal government's largest grant-making agency. discharge of debtor - Answer a potential outcome of bankruptcy that is releases the guarantor/patient from financial responsibility of any and all account balances listed on the bankruptcy petition; the account balance is to be written off to the appropriate transaction code.