CHAA 2021 Study Guide Questions and
Answers|Latest Update
Lifetime Maximum Many 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 "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 According 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 The 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 is 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: Facilities are performing in terms of data collection,
timely billing, accurate reimbursement and other revenue-cycle-related criteria.
Point-of-service (POS) collection means collecting the patient's portion of the bill at the
time service is rendered.
Valid Physician Order Legibility, 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, and physician signature.
Verify the Physicians Patient Access should ________________________________ 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.
,Ways to identify a patient Date of Birth, legal name, SS#, address, place of employment,
employment status, retirement or disability status, martial status, race or ethincy, and insurance
information are all ways to: __________________________
Information Systems _______________________ supports level of care, clinical care,
clerical administration, financial collection and reimbursement, data retention, statistics, finance,
reporting, risk management, quality review and patient identification.
Automation Services Can help with or hindrance in ensuring patient identity and securing
protected patient information to meet HIPAA and other compliance regulations."
Downtime out of service from time to time, sometimes intentionally for scheduled
maintenance and upgrades, other times not. Partial or complete unavailability of automated
systems from time to time
Hardware keyboards, monitors, central processing units (CPU), servers, printers, cables
and cords, credit card machines, kiosks, ten key pad, web cameras, tablets, interpreter system, etc
Healthcare Systems Dependent on IT Systems
______________________________________ is depended on several important duties in
, the healthcare world. Such as the master index, patient data collection and processing systems,
such as scheduling, pre-registration, authorization and verification. Clinical data repositories (or
data warehouse) Nightly batch processing, Connectivity to insurance and government websites
for insurance information, Automated payment systems, automated calling systems, kiosks, and
patient portals.
Schedule Downtime "occurs on a predictable basis. Procedures for conducting business
during these periods are typically well-documented in the Access Department and may involve
collecting patient data manually and entering it online in a timely manner when the system
comes back up."
Software systems programs that make the computers run (operating systems such as
Windows and DOS), application programs (registration program, QA, eligibility, address
verification, medical necessity) and interfaces
transitional "catch-up" During which the system comes up after a period of downtime
Unscheduled downtime "is when one or more systems fail to function, often negatively
impacting other interfaced systems. The source of the outage may be external, such as a natural
disaster, or internal, such as a system crash. "
Answers|Latest Update
Lifetime Maximum Many 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 "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 According 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 The 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 is 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: Facilities are performing in terms of data collection,
timely billing, accurate reimbursement and other revenue-cycle-related criteria.
Point-of-service (POS) collection means collecting the patient's portion of the bill at the
time service is rendered.
Valid Physician Order Legibility, 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, and physician signature.
Verify the Physicians Patient Access should ________________________________ 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.
,Ways to identify a patient Date of Birth, legal name, SS#, address, place of employment,
employment status, retirement or disability status, martial status, race or ethincy, and insurance
information are all ways to: __________________________
Information Systems _______________________ supports level of care, clinical care,
clerical administration, financial collection and reimbursement, data retention, statistics, finance,
reporting, risk management, quality review and patient identification.
Automation Services Can help with or hindrance in ensuring patient identity and securing
protected patient information to meet HIPAA and other compliance regulations."
Downtime out of service from time to time, sometimes intentionally for scheduled
maintenance and upgrades, other times not. Partial or complete unavailability of automated
systems from time to time
Hardware keyboards, monitors, central processing units (CPU), servers, printers, cables
and cords, credit card machines, kiosks, ten key pad, web cameras, tablets, interpreter system, etc
Healthcare Systems Dependent on IT Systems
______________________________________ is depended on several important duties in
, the healthcare world. Such as the master index, patient data collection and processing systems,
such as scheduling, pre-registration, authorization and verification. Clinical data repositories (or
data warehouse) Nightly batch processing, Connectivity to insurance and government websites
for insurance information, Automated payment systems, automated calling systems, kiosks, and
patient portals.
Schedule Downtime "occurs on a predictable basis. Procedures for conducting business
during these periods are typically well-documented in the Access Department and may involve
collecting patient data manually and entering it online in a timely manner when the system
comes back up."
Software systems programs that make the computers run (operating systems such as
Windows and DOS), application programs (registration program, QA, eligibility, address
verification, medical necessity) and interfaces
transitional "catch-up" During which the system comes up after a period of downtime
Unscheduled downtime "is when one or more systems fail to function, often negatively
impacting other interfaced systems. The source of the outage may be external, such as a natural
disaster, or internal, such as a system crash. "
