CHAA Certification Exam 100% Correct!!
Accepting Assignment - ANSWERSWhen a provider agrees to accept the allowable
charges as the full fee and cannot charge the patient the difference between the
insurance payment and the provider's normal fee.
Access - ANSWERSThe Patient's ability to obtain medical care. The ease of access is
determined by such components as the availability of medical services and their
acceptability to the patient, the location of health care facilities, transportation, hours of
operation and cost of care.
Account Number - ANSWERSA number assigned to each account. The number is used
to identify the account and all charges and payments received.
Acute Care - ANSWERSMedical 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 - ANSWERSA level of health care delivered to patients
experiencing acute illness or trauma. Acute care is generally short-term less than 30
days.
Add-Ons - ANSWERSPatients who are scheduled for services less than 24 hours in
advance of the actual service time.
Adjustor - ANSWERSInsurance company representative
Administrative Costs - ANSWERSCosts associated with creating and submitting a bill
for services, which could include, registration, utilization review, coding, billing, and
collection expenses.
Admission Authorization - ANSWERSThe process of third party payor notification of
urgent/emergent inpatient admission within specified time as determined by payors
which is usually within a 24 to 48 hour or next business day.
Admission Date - ANSWERSThe first date the patient entered the hospital for a specific
visit.
Admitting Diagnosis - ANSWERSWord, phrase, International Classification of Disease
(ICD9) code used by the admitting physician to identify a condition or disease from
which a patient suffers and for which the patient needs or seeks medical care.
, Admitting Physician - ANSWERSThe physician who writes the order for the patient to
be admitted to the hospital. The physician must have admitting privileges at the facility
providing the health care services.
Advance Beneficiary Notice (ABN) - ANSWERSA notice that a care provider should
give a Medicare beneficiary to sign if the services being provided may not be
considered medically necessary and Medicare may not pay for them. The advanced
beneficiary notice (ABN) allows the beneficiary to make a informed decision prior to
services whether or not he/she wishes to receive services. ABNs are not routinely given
to emergency department patients.
Advanced Directives - ANSWERSAn advance directive is a written instruction relating to
the provision of health care when a patient is incapacitated. It could include appointing
someone to make medical decisions, a state expressing the patients wishes about
anatomical gifts (like organ donation), and general statements about whether or not life-
sustaining treatments should be withheld or withdrawn.
Adverse Selection - ANSWERSAmong applicants for a given group or individual
program, the tendency for those with an impaired health status, or who are prone to
higher than average utilization of benefits to be enrolled in disproportionate numbers
and lower deductible plans.
Alias - ANSWERSAn alias is a name by which the patient is also known as or formerly
known as.
All patient Diagnosis Related Groups Assignment of Benefits (APDRG) - ANSWERSA
prospective hospital claims reimbursement system currently utilized by the federal
government Medicaid program and the states of New York and New Jersey. APDRGs
were designed to describe the complete cross section of patients seen in acute care
hospitals. Approximately 639 APDRGs are defined according to the principal diagnosis,
secondary diagnoses, procedures, age, birth weight, sex, discharge status. Each
category has an established fixed reimbursement rate based on average cost of
treatment within a geographic area. APRDRG's were developed to quantify the
difference in demographic
groups and clinical risk factors for patients treated in hospitals. This proprietary grouping
system's (i.e. 3M) purpose is to obtain fair and accurate statistical comparisons between
disparate populations and groups. Unlike the Diagnosis Related Group (DRG)
reimbursement system which is intended to capture
resource utilization intensity, the APRDRG system captures and relates the Severity of
Illness and Risk of Mortality factors present as a result of a patient's disease and
disorders and the interaction of those disorders. A form is signed by the Patient giving
the healthcare provider authority to bill his/her insurance plan and receive payment. The
form is generally presented and signed at the time of registration.
Accepting Assignment - ANSWERSWhen a provider agrees to accept the allowable
charges as the full fee and cannot charge the patient the difference between the
insurance payment and the provider's normal fee.
Access - ANSWERSThe Patient's ability to obtain medical care. The ease of access is
determined by such components as the availability of medical services and their
acceptability to the patient, the location of health care facilities, transportation, hours of
operation and cost of care.
Account Number - ANSWERSA number assigned to each account. The number is used
to identify the account and all charges and payments received.
Acute Care - ANSWERSMedical 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 - ANSWERSA level of health care delivered to patients
experiencing acute illness or trauma. Acute care is generally short-term less than 30
days.
Add-Ons - ANSWERSPatients who are scheduled for services less than 24 hours in
advance of the actual service time.
Adjustor - ANSWERSInsurance company representative
Administrative Costs - ANSWERSCosts associated with creating and submitting a bill
for services, which could include, registration, utilization review, coding, billing, and
collection expenses.
Admission Authorization - ANSWERSThe process of third party payor notification of
urgent/emergent inpatient admission within specified time as determined by payors
which is usually within a 24 to 48 hour or next business day.
Admission Date - ANSWERSThe first date the patient entered the hospital for a specific
visit.
Admitting Diagnosis - ANSWERSWord, phrase, International Classification of Disease
(ICD9) code used by the admitting physician to identify a condition or disease from
which a patient suffers and for which the patient needs or seeks medical care.
, Admitting Physician - ANSWERSThe physician who writes the order for the patient to
be admitted to the hospital. The physician must have admitting privileges at the facility
providing the health care services.
Advance Beneficiary Notice (ABN) - ANSWERSA notice that a care provider should
give a Medicare beneficiary to sign if the services being provided may not be
considered medically necessary and Medicare may not pay for them. The advanced
beneficiary notice (ABN) allows the beneficiary to make a informed decision prior to
services whether or not he/she wishes to receive services. ABNs are not routinely given
to emergency department patients.
Advanced Directives - ANSWERSAn advance directive is a written instruction relating to
the provision of health care when a patient is incapacitated. It could include appointing
someone to make medical decisions, a state expressing the patients wishes about
anatomical gifts (like organ donation), and general statements about whether or not life-
sustaining treatments should be withheld or withdrawn.
Adverse Selection - ANSWERSAmong applicants for a given group or individual
program, the tendency for those with an impaired health status, or who are prone to
higher than average utilization of benefits to be enrolled in disproportionate numbers
and lower deductible plans.
Alias - ANSWERSAn alias is a name by which the patient is also known as or formerly
known as.
All patient Diagnosis Related Groups Assignment of Benefits (APDRG) - ANSWERSA
prospective hospital claims reimbursement system currently utilized by the federal
government Medicaid program and the states of New York and New Jersey. APDRGs
were designed to describe the complete cross section of patients seen in acute care
hospitals. Approximately 639 APDRGs are defined according to the principal diagnosis,
secondary diagnoses, procedures, age, birth weight, sex, discharge status. Each
category has an established fixed reimbursement rate based on average cost of
treatment within a geographic area. APRDRG's were developed to quantify the
difference in demographic
groups and clinical risk factors for patients treated in hospitals. This proprietary grouping
system's (i.e. 3M) purpose is to obtain fair and accurate statistical comparisons between
disparate populations and groups. Unlike the Diagnosis Related Group (DRG)
reimbursement system which is intended to capture
resource utilization intensity, the APRDRG system captures and relates the Severity of
Illness and Risk of Mortality factors present as a result of a patient's disease and
disorders and the interaction of those disorders. A form is signed by the Patient giving
the healthcare provider authority to bill his/her insurance plan and receive payment. The
form is generally presented and signed at the time of registration.
