CHAA 2021 Study Guide 100%
Accurate!!
A financial counselor/Financial Assistance - ANSWERSIn accordance with Section
501(r) regulations through the Affordable Care Act, a hospital must establish a written
financial assistance policy and make it available to patients.
Batch Processing - ANSWERSExecution of a series of jobs in a computer program
without manual intervention; it is used to help maximize the use of computer resources
and stabilize response time by performing system-intensive work during hours when
users are less likely to require access. Unlike real-time transactions, jobs executed in
batch are not available for users to view until after the batch is run
A Valid Physician Order - ANSWERSLegibility Patient name Date (must be within
specified timeline - 30 days or as defined by state statute and/or facility policy) Test or
therapy ordered Diagnosis, signs or symptoms Physician signature
Patient Contact Center - ANSWERSA central point in an organization from which all
customer contacts are managed, including scheduling, pre-registration, pre-verification,
prior authorization, functions, etc.
Pricing Transparency - ANSWERSIn 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 - ANSWERSA 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
Access Keys - ANSWERSNAHAM has developed a series of guidelines that identify
performance criteria, explain how to measure them and provide Good/Better/Best
benchmarks for facilities to measure. These are called:
Ambulatory Payment Classifications (APCs) - ANSWERS"Codes billed for outpatient
services preformed at a hospital. is calculated based on the national average cost
(operating and capital) of the hospitals"
Authorization - ANSWERSmeans a determination required under a health benefits plan,
which based on the information provided, satisfies the requirements under the
member's health benefits plan for medical necessity
,Benefits for Automated Quality Assurance - ANSWERS100% of registration audited,
patients access associated receive feedback on errors and can self correct, Errors
corrected earlier in the revenue cycle, and clean data before the bill drops.
BIRTHDAY RULE - ANSWERSAccording to the birthday rule, the primary plan for a
child is the health plan of the parent whose birthday comes first in the calendar year.
Remember this is the date, not the year. If both birthdays fall on the same day, then the
plan that has been in effect longer is primary.
CMS 1450 (UB-04) (UB-92) - ANSWERSa federal directive requiring a hospital to follow
specific billing procedures, itemizing all services included and billed for on each invoice.
Use by hospitals, skilled nursing facilities, home health agencies, community mental
health facilities,
Minimum Necessary Standard - ANSWERSpeople should only access, use or disclose
the health information that is minimally necessary to accomplish a given task or
purpose.
Coordination of benefits (COB) - ANSWERSis a way of determining the order in which
benefits are paid, and the amounts that are payable, when a patient is covered by more
than one health plan.
(HCAHPS) Hospital Consumer Assessment of Healthcare Providers - ANSWERSAlso
known as Hospital CAHPS, it stands for Hospital Consumer Assessment of Healthcare
Providers and Systems and is a standardized survey of hospital patients that will
capture patients' unique perspectives on hospital care for the purpose of providing the
public with comparable information on hospital quality.
Co-pay - ANSWERSIs used by physicians and other clinicians. It is a fixed amount that
the beneficiary pays for healthcare services, regardless of the actual charge; the
amount is designated by an insurer as the patient's responsibility.
Critical Data Elements (CDEs) - ANSWERSCommonly entered errors
Current Procedural Terminology (CPT) - ANSWERScodes, which are used for coding
procedures is used to classify services provided by physicians, hospitals and
ambulatory surgery centers
Exclusions - ANSWERSCertain procedures are excluded from the plan. Asking the
insurance company will let you know what services are not included and covered in the
plan.
Financial counseling/Financial investigation - ANSWERSIs a method through which the
provider identifies actual payment sources and alternatives for the patient to pay the bill
, Form locator - ANSWERSis the name of the data fields on each of the uniform bills (i.e.,
UB-04). The UB-04 has 81 numerically sequenced form locators, while the 1500 has 33
form locators.
Healthcare Common Procedure Coding Systems - ANSWERS"is used to classify items
and services provided in the delivery of healthcare. Level II codes used to classify non-
physician services."
International Classification of Diseases, Ninth Revision, Clinical Modifications -
ANSWERSWas developed and implemented October 1, 2015. Classification system
includes diseases, injuries and procedures
Lifetime Maximum - ANSWERSMany payers have a calendar year and a lifetime
maximum limit on benefits paid. Once the maximum has been reached, the benefits
have been exhausted. There are no more funds available for coverage of any further
services.
master patient index - ANSWERS"Is the primary patient tracking link and therefore
considered the most important resource in a healthcare facility. It's used to match
patients being registered for care to their medical record and minimize duplicate medical
records"
Medical necessity - ANSWERSAccording to Medicare.gov, is defined as "healthcare
services or supplies needed to prevent, diagnose or treat an illness, injury, condition,
disease or its symptoms and that meet accepted standards of medicine."
Out-of-Pocket Maximum - ANSWERSThe total payments toward eligible expenses that
a covered person funds for him/herself and/or dependents. These expenses may
include deductibles, co-pays and coinsurance as defined by the contract. Once this limit
is reached, benefits will increase to 100 percent for health services received during the
rest of that calendar or policy year. Deductibles may or may not be included in out-of-
pocket limits.
Patient Access Primary Role - ANSWERSis to create the basis of the medical record
through the capture of specific information prior to the patient's encounter or at the point
of entry into the healthcare system.
Performance Standards May Include: - ANSWERSFacilities are performing in terms of
data collection, timely billing, accurate reimbursement and other revenue-cycle-related
criteria.
Point-of-service (POS) collection - ANSWERSmeans collecting the patient's portion of
the bill at the time service is rendered.
Accurate!!
A financial counselor/Financial Assistance - ANSWERSIn accordance with Section
501(r) regulations through the Affordable Care Act, a hospital must establish a written
financial assistance policy and make it available to patients.
Batch Processing - ANSWERSExecution of a series of jobs in a computer program
without manual intervention; it is used to help maximize the use of computer resources
and stabilize response time by performing system-intensive work during hours when
users are less likely to require access. Unlike real-time transactions, jobs executed in
batch are not available for users to view until after the batch is run
A Valid Physician Order - ANSWERSLegibility Patient name Date (must be within
specified timeline - 30 days or as defined by state statute and/or facility policy) Test or
therapy ordered Diagnosis, signs or symptoms Physician signature
Patient Contact Center - ANSWERSA central point in an organization from which all
customer contacts are managed, including scheduling, pre-registration, pre-verification,
prior authorization, functions, etc.
Pricing Transparency - ANSWERSIn 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 - ANSWERSA 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
Access Keys - ANSWERSNAHAM has developed a series of guidelines that identify
performance criteria, explain how to measure them and provide Good/Better/Best
benchmarks for facilities to measure. These are called:
Ambulatory Payment Classifications (APCs) - ANSWERS"Codes billed for outpatient
services preformed at a hospital. is calculated based on the national average cost
(operating and capital) of the hospitals"
Authorization - ANSWERSmeans a determination required under a health benefits plan,
which based on the information provided, satisfies the requirements under the
member's health benefits plan for medical necessity
,Benefits for Automated Quality Assurance - ANSWERS100% of registration audited,
patients access associated receive feedback on errors and can self correct, Errors
corrected earlier in the revenue cycle, and clean data before the bill drops.
BIRTHDAY RULE - ANSWERSAccording to the birthday rule, the primary plan for a
child is the health plan of the parent whose birthday comes first in the calendar year.
Remember this is the date, not the year. If both birthdays fall on the same day, then the
plan that has been in effect longer is primary.
CMS 1450 (UB-04) (UB-92) - ANSWERSa federal directive requiring a hospital to follow
specific billing procedures, itemizing all services included and billed for on each invoice.
Use by hospitals, skilled nursing facilities, home health agencies, community mental
health facilities,
Minimum Necessary Standard - ANSWERSpeople should only access, use or disclose
the health information that is minimally necessary to accomplish a given task or
purpose.
Coordination of benefits (COB) - ANSWERSis a way of determining the order in which
benefits are paid, and the amounts that are payable, when a patient is covered by more
than one health plan.
(HCAHPS) Hospital Consumer Assessment of Healthcare Providers - ANSWERSAlso
known as Hospital CAHPS, it stands for Hospital Consumer Assessment of Healthcare
Providers and Systems and is a standardized survey of hospital patients that will
capture patients' unique perspectives on hospital care for the purpose of providing the
public with comparable information on hospital quality.
Co-pay - ANSWERSIs used by physicians and other clinicians. It is a fixed amount that
the beneficiary pays for healthcare services, regardless of the actual charge; the
amount is designated by an insurer as the patient's responsibility.
Critical Data Elements (CDEs) - ANSWERSCommonly entered errors
Current Procedural Terminology (CPT) - ANSWERScodes, which are used for coding
procedures is used to classify services provided by physicians, hospitals and
ambulatory surgery centers
Exclusions - ANSWERSCertain procedures are excluded from the plan. Asking the
insurance company will let you know what services are not included and covered in the
plan.
Financial counseling/Financial investigation - ANSWERSIs a method through which the
provider identifies actual payment sources and alternatives for the patient to pay the bill
, Form locator - ANSWERSis the name of the data fields on each of the uniform bills (i.e.,
UB-04). The UB-04 has 81 numerically sequenced form locators, while the 1500 has 33
form locators.
Healthcare Common Procedure Coding Systems - ANSWERS"is used to classify items
and services provided in the delivery of healthcare. Level II codes used to classify non-
physician services."
International Classification of Diseases, Ninth Revision, Clinical Modifications -
ANSWERSWas developed and implemented October 1, 2015. Classification system
includes diseases, injuries and procedures
Lifetime Maximum - ANSWERSMany payers have a calendar year and a lifetime
maximum limit on benefits paid. Once the maximum has been reached, the benefits
have been exhausted. There are no more funds available for coverage of any further
services.
master patient index - ANSWERS"Is the primary patient tracking link and therefore
considered the most important resource in a healthcare facility. It's used to match
patients being registered for care to their medical record and minimize duplicate medical
records"
Medical necessity - ANSWERSAccording to Medicare.gov, is defined as "healthcare
services or supplies needed to prevent, diagnose or treat an illness, injury, condition,
disease or its symptoms and that meet accepted standards of medicine."
Out-of-Pocket Maximum - ANSWERSThe total payments toward eligible expenses that
a covered person funds for him/herself and/or dependents. These expenses may
include deductibles, co-pays and coinsurance as defined by the contract. Once this limit
is reached, benefits will increase to 100 percent for health services received during the
rest of that calendar or policy year. Deductibles may or may not be included in out-of-
pocket limits.
Patient Access Primary Role - ANSWERSis to create the basis of the medical record
through the capture of specific information prior to the patient's encounter or at the point
of entry into the healthcare system.
Performance Standards May Include: - ANSWERSFacilities are performing in terms of
data collection, timely billing, accurate reimbursement and other revenue-cycle-related
criteria.
Point-of-service (POS) collection - ANSWERSmeans collecting the patient's portion of
the bill at the time service is rendered.
