ACMA CERTIFICATION LATEST EXAM ACTUAL
QUESTIONS AND ANSWERS SURE A+
✔✔Condition Code 44 - ✔✔Medicare only.
When UR committee consults with MD determines that admission is not medically
necessary but observation is appropriate.
Change to obs is permissible if all is met 1)Change is made before discharge 2)hospital
has not submitted a claim for inpatient 3) The MD agrees with decision of UR 4)
Documented why change made in medical record with orders, Pt must be informed.
-If conditions not met, can bill Part B Medicare.
✔✔Conditions of Participation (CoP) - ✔✔Conditions that healthcare organizations must
meet in order to participate with Medicare and Medicaid. UR and DCP.
DCP applies to all patients and hospitals must have a process to identify patients likely
to have adverse events without DCP. DCP assessment must be provided for these
patients as well as those who patients/families/MDs request. Hospitals can choose
whether to see everyone or just those at risk.
Requires detailed discharge instructions be provided to pt and caregiver. Staff must
teach back.
, ✔✔Continued Stay Review - ✔✔Ongoing assessment of patient's progress through
review of physician documentation. Determined whether continued stay should occur or
move to another level or care or discharge.
✔✔Core measures - ✔✔key quality indicators that help health care institutions improve
performance, increase accountability, and reduce costs
✔✔Detailed Notice of Discharge (DND) - ✔✔Full explanation for hospital discharge and
why services are no longer covered by medicare
✔✔Diagnosis-related groups (DRGs) - ✔✔System that categorizes into payment groups
patients who are medically related with respect to diagnosis and treatment and
statistically similar with regard to length of stay
✔✔Extended Stay/ Recovery - ✔✔outpatients in a bed who do not meet inpatient or
observation. Room and board not billable generally.
✔✔face to face - ✔✔Needed for home health. NP/PA can do face to face with
collaboration with MD. Clinical documentation, homebound status, need for skilled
services. Face to face must occur within 90 days prior to starting services and 30 days
afterwards.
✔✔Health Insurance Portability and Accountability Act (HIPAA) - ✔✔Protected health
information. Office of Civil Rights enforces.
✔✔Hospital-Issued Notice of Noncoverage (HINN) - ✔✔A hospital notice to a
beneficiary that is provided to inform the patient that the inpatient care the beneficiary is
receiving or about to receive is not covered. Can be delivered any time the hospital
determines not covered.
✔✔Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) -
✔✔Patient Survey developed by CMS with the agency for healthcare research and
quality (AHRQ). Questions include experience of care, communication, pain
management, hospital environment, perspective of hospital staff communication about
discharge plan and written info on symptoms to be on alert for after discharge.
Also asks patient if hospital staff took patient/family preferences into account when
deciding healthcare plans and if patient had good understanding of medications and
aftercare.
✔✔Inpatient - ✔✔Formally admitted by hospital with MD orders. The day before patient
discharges is last inpatient day. Generally appropriate if patient needs 2 or more
midnights of medically necessary care.
QUESTIONS AND ANSWERS SURE A+
✔✔Condition Code 44 - ✔✔Medicare only.
When UR committee consults with MD determines that admission is not medically
necessary but observation is appropriate.
Change to obs is permissible if all is met 1)Change is made before discharge 2)hospital
has not submitted a claim for inpatient 3) The MD agrees with decision of UR 4)
Documented why change made in medical record with orders, Pt must be informed.
-If conditions not met, can bill Part B Medicare.
✔✔Conditions of Participation (CoP) - ✔✔Conditions that healthcare organizations must
meet in order to participate with Medicare and Medicaid. UR and DCP.
DCP applies to all patients and hospitals must have a process to identify patients likely
to have adverse events without DCP. DCP assessment must be provided for these
patients as well as those who patients/families/MDs request. Hospitals can choose
whether to see everyone or just those at risk.
Requires detailed discharge instructions be provided to pt and caregiver. Staff must
teach back.
, ✔✔Continued Stay Review - ✔✔Ongoing assessment of patient's progress through
review of physician documentation. Determined whether continued stay should occur or
move to another level or care or discharge.
✔✔Core measures - ✔✔key quality indicators that help health care institutions improve
performance, increase accountability, and reduce costs
✔✔Detailed Notice of Discharge (DND) - ✔✔Full explanation for hospital discharge and
why services are no longer covered by medicare
✔✔Diagnosis-related groups (DRGs) - ✔✔System that categorizes into payment groups
patients who are medically related with respect to diagnosis and treatment and
statistically similar with regard to length of stay
✔✔Extended Stay/ Recovery - ✔✔outpatients in a bed who do not meet inpatient or
observation. Room and board not billable generally.
✔✔face to face - ✔✔Needed for home health. NP/PA can do face to face with
collaboration with MD. Clinical documentation, homebound status, need for skilled
services. Face to face must occur within 90 days prior to starting services and 30 days
afterwards.
✔✔Health Insurance Portability and Accountability Act (HIPAA) - ✔✔Protected health
information. Office of Civil Rights enforces.
✔✔Hospital-Issued Notice of Noncoverage (HINN) - ✔✔A hospital notice to a
beneficiary that is provided to inform the patient that the inpatient care the beneficiary is
receiving or about to receive is not covered. Can be delivered any time the hospital
determines not covered.
✔✔Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) -
✔✔Patient Survey developed by CMS with the agency for healthcare research and
quality (AHRQ). Questions include experience of care, communication, pain
management, hospital environment, perspective of hospital staff communication about
discharge plan and written info on symptoms to be on alert for after discharge.
Also asks patient if hospital staff took patient/family preferences into account when
deciding healthcare plans and if patient had good understanding of medications and
aftercare.
✔✔Inpatient - ✔✔Formally admitted by hospital with MD orders. The day before patient
discharges is last inpatient day. Generally appropriate if patient needs 2 or more
midnights of medically necessary care.
