CHAA Study Guide Latest Version Graded A

CHAA Study Guide Latest Version Graded A Accreditation Defined as "a self-assessment and external peer assessment process used by healthcare organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve." Examples include: TJC, Healthcare Accreditation Program, DNVGL helps organize patient safety efforts, improves risk management, provides education, provides professional advice, authority for Medicare certification and other third party insurers Quality Improvement Initiatives gathering and analyzing data from patient satisfaction surveys to initiate education and remedial action and then evaluate actions taken. Acute care 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 A level of healthcare delivered to patients experiencing acute illness or trauma. Is generally short-term (30 days). Advance Beneficiary Notice (ABN) Written notice issued to a fee-for-service (Original Medicare) beneficiary before furnishing items or services that are usually covered by Medicare but are not expected to be paid in a specific instance for certain reasons, such as lack of medical necessity. If not given, patient cannot be billed for service. Advance Directive Also known as a medical directive, healthcare directive or a living will, a legal document in which a person has outlined what they would like to be done if they are no longer able to make decisions for themselves due to incapacity or illness. Ambulatory Services/Same-Day Surgery Patient receives surgical treatment and is discharged from the facility within four to six hours of procedure. _______ can occur in an outpatient hospital department or in a freestanding ambulatory care facility. Ancillary Services Physician refers patients for scheduled and non-scheduled services such as radiology, laboratory, and/or other services that are performed in a hospital or clinic setting. Patients leave the facility once the services are completed. Anti-Kickback Statute Anti-fraud federal criminal statute that prohibits offering or exchange of anything of value in exchange for healthcare business referrals, including cash, rent, expensive hotel stays, etc. Authorization Requirement Certain services need _____ while other procedures might not. Some insurance companies require a CPT code, so make sure you have that available. Batch Processing Execution 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 ______ are not available for users to view until after the _____ is run. Carve Out A decision to separately purchase a service, which is typically a part of an indemnity of an HMO plan. For example, an HMO may "_________" the behavioral health benefits and select a specialized vendor to supply these services on a stand-alone basis. ____________ may also include medical devices that the plan pays for in addition to the contracted per diem or case rate. Pre-certification/pre-authorization is often required for these benefits and services. Case Management Coordination of services to help meet a patient's healthcare needs. Centers for Medicare and Medicaid Services (CMS) Federal agency under the Department of Health and Humans Services (HHS) that administers Medicare and partners with state governments for administration of Medicaid and other programs, including the Children's Health Insurance Program (CHIP). Civilian Health and Medical Program for the Veterans Administration (CHAMPVA) The _______ is an insurance program for the families of veterans who are not eligible for Tricare. Charity care Free or discounted medical care provided to patients who do not have the ability to pay for all or a part of medical costs due to limited income or financial hardship. Co-insurance The percentage amount that is payable, per policy provisions, toward medical costs after the deductible has been met. For example, a patient's _________ amount may be 20 percent, and the insurance company's _________ could be 80 percent under a contract. Condition code 44 Sometimes a Medicare patient is admitted to a hospital as an inpatient but, upon internal review, the hospital determines the services did not meet inpatient criteria and the admission is changed to observation. This rule has become informally known as "______________."