CHAA FINAL EXAM 2026 ACTUAL QUESTIONS AND
ANSWERS GRADED A+
✔✔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 authorizations 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 batch
are not available for users to view until after the batch 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 "carve out" the behavioral
health benefits and select a specialized vendor to supply these services on a stand-
alone basis. Carve outs 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).
✔✔CHAMPVA - ✔✔The Civilian Health and Medical Program for the Veterans
Administration is an insurance program for the families of veterans.
-CHAMPVA is always secondary to Medicare
-CHAMPVA is secondary to other insurance plans except Medicaid
✔✔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
coinsurance amount may be 20 percent, and the insurance company's coinsurance
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 "condition code 44."
✔✔Co-payment - ✔✔A payment that must be made by a covered person at the time of
service. Services that require a co-pay, and the predetermined amount payable for each
service, are specified in the policy. Co-payments may be required for physician visits,
prescriptions or hospital services.
✔✔Electronic protected health information (ePHI) - ✔✔Any protected health information
(PHI) as identified under HIPAA that is produced, saved, received or transferred in an
electronic format.
✔✔Deductible - ✔✔The amount of eligible expenses a covered person must pay each
year from his/her own pocket before the plan will begin to pay for eligible benefits.
✔✔DNV-GL Accreditation - ✔✔DNV Healthcare is an accreditation organization
approved by CMS in 2008 that has accredited approximately 500 hospitals.
It integrates the CMS Conditions of Participation with the IDO 9001 Quality
Management program. Its survey teams visit annually. It offers several certifications,
such as Managing Infection Risk and Primary Stroke Center. Its tagline is "Safer,
Smarter, Greener."
✔✔Downtime - ✔✔Time the computer system is unavailable to users.
✔✔Electronic health record (EHR) - ✔✔A real-time, digitized version of a patient's
medical history that allows secure information access to authorized users. Standard
clinical and medical data is gathered by a provider and stored in electronic files. EHR
goes beyond a single provider and can contain shared information from multiple
providers to develop a comprehensive patient history.
✔✔Emergency Medical Treatment and Labor Act (EMTALA) - ✔✔"Anti-Dumping"
statute. Federal law protecting patients against discrimination regardless of ability to
pay; mandates patients receive a medical screening exam and stabilizing treatment
when seeking emergency medical care or when in active labor.
,✔✔Emergency Services - ✔✔Patients examined on an unscheduled emergent basis for
immediate treatment in the emergency facilities of a hospital. Depending on the
outcome of the exam and treatment, the patient may be admitted as an observation
patient, admitted to the facility as an inpatient, or transferred to another facility as
deemed necessary by the physician.
✔✔Ethnicity - ✔✔A social group that shares a common and distinctive culture, religion,
language or the like.
✔✔Exclusions - ✔✔Certain procedures are excluded from the plan. Asking the
insurance company will let you know what services are not included and covered in the
plan.
✔✔Fair Debt Collection Practices Act (FDCPA) - ✔✔Federal law prohibiting debt
collectors from using unfair, abusive or deceptive practices while attempting to collect
from a consumer.
✔✔False Claims Act - ✔✔Federal law targets fraud against the government.
"Whistleblower's"/qui tam provision allows non-government individuals to "blow the
whistle" in good faith on fraud against the government who may receive up to 30
percent of any recovered damages.
✔✔HCAHPS - ✔✔Also 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.
✔✔Health Exchange - ✔✔Health Insurance Marketplace or "Exchange" —
organizations that facilitate structured and competitive markets for purchasing health
coverage.
✔✔Health Information Technology for Economic and Clinical Health Act of 2009
(HITECH) - ✔✔Federal law stimulating the adoption of electronic health records and
providing financial incentives for demonstrating meaningful use; also expanded HIPAA
security and privacy rules and increased penalties; established data breach notification
rules. HITECH added data breach notification rules and increased penalties and fines to
ensure that any EHR technology created under HITECH does not compromise the
HIPAA security and privacy laws.
✔✔Health Insurance Portability and Accountability Act of 1996 (HIPAA) - ✔✔Originally
focused on regulations related to health insurance portability; focused on administration
simplification and reduction of cost through the protection and standardization of
electronic and financial records. Most known for the privacy rule and security rule, these
rules defined standards for healthcare and protected healthcare information (PHI).
, ✔✔Healthcare Facilities Accreditation Program (HFAP) - ✔✔An accrediting organization
tied to Medicare Conditions of Participation Coverages.
✔✔HITECH Omnibus of 2013 - ✔✔This update to the HITECH Act revised provisions
that focused on an individual's right to request restrictions on the disclosure of PHI
(restricted disclosure) and on an individual's right to access his or her PHI stored in an
EHR.
✔✔Hospice - ✔✔A non-profit organization dedicated to patients and families facing
serious illness or death. Hospice provides a support system to patients and families who
choose to share their last days together in the comfort of their home or hospice
designated facility. Hospice provides a wide range of services that include: coordination
of care with the patient's primary care physician, skilled nursing visits, spiritual
counseling and social worker support. The hospice staff are an interdisciplinary team
who coordinate an individualized plan of care for each patient that is directed by the
Primary Care Physician. Hospice care is a covered service under the Medicare
program.
✔✔Icon - ✔✔A graphic symbol for an application, file or folder.
✔✔Important Message from Medicare (IMM) - ✔✔IMM is a form given to all Medicare
beneficiaries who are inpatients in participating hospitals explaining their rights and
what to do if they feel they are being discharged early.
It explains:
-Rights as hospital patients, including the right to all the hospital care needed and
follow-up care after discharge
-Advises beneficiaries about what to do if they feel they are being discharged early and
provides the phone number for the PRO (Peer Review Organization). Beneficiaries may
remain in the hospital without being charged while the case is being reviewed. Hospitals
cannot force beneficiaries to leave while their case is being reviewed.
✔✔Insurance eligibility - ✔✔The person entitled to benefits and is covered. The date
they became eligible for the plan is important to know since information can change
from month to month along with the termination date of coverage.
✔✔Level of Service - ✔✔The type of care a patient need for their stay. There are three
levels of service: Intensive Care (ICU), step down, floor, observation and outpatient.
✔✔Lifetime Maximum - ✔✔What is their 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.
ANSWERS GRADED A+
✔✔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 authorizations 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 batch
are not available for users to view until after the batch 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 "carve out" the behavioral
health benefits and select a specialized vendor to supply these services on a stand-
alone basis. Carve outs 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).
✔✔CHAMPVA - ✔✔The Civilian Health and Medical Program for the Veterans
Administration is an insurance program for the families of veterans.
-CHAMPVA is always secondary to Medicare
-CHAMPVA is secondary to other insurance plans except Medicaid
✔✔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
coinsurance amount may be 20 percent, and the insurance company's coinsurance
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 "condition code 44."
✔✔Co-payment - ✔✔A payment that must be made by a covered person at the time of
service. Services that require a co-pay, and the predetermined amount payable for each
service, are specified in the policy. Co-payments may be required for physician visits,
prescriptions or hospital services.
✔✔Electronic protected health information (ePHI) - ✔✔Any protected health information
(PHI) as identified under HIPAA that is produced, saved, received or transferred in an
electronic format.
✔✔Deductible - ✔✔The amount of eligible expenses a covered person must pay each
year from his/her own pocket before the plan will begin to pay for eligible benefits.
✔✔DNV-GL Accreditation - ✔✔DNV Healthcare is an accreditation organization
approved by CMS in 2008 that has accredited approximately 500 hospitals.
It integrates the CMS Conditions of Participation with the IDO 9001 Quality
Management program. Its survey teams visit annually. It offers several certifications,
such as Managing Infection Risk and Primary Stroke Center. Its tagline is "Safer,
Smarter, Greener."
✔✔Downtime - ✔✔Time the computer system is unavailable to users.
✔✔Electronic health record (EHR) - ✔✔A real-time, digitized version of a patient's
medical history that allows secure information access to authorized users. Standard
clinical and medical data is gathered by a provider and stored in electronic files. EHR
goes beyond a single provider and can contain shared information from multiple
providers to develop a comprehensive patient history.
✔✔Emergency Medical Treatment and Labor Act (EMTALA) - ✔✔"Anti-Dumping"
statute. Federal law protecting patients against discrimination regardless of ability to
pay; mandates patients receive a medical screening exam and stabilizing treatment
when seeking emergency medical care or when in active labor.
,✔✔Emergency Services - ✔✔Patients examined on an unscheduled emergent basis for
immediate treatment in the emergency facilities of a hospital. Depending on the
outcome of the exam and treatment, the patient may be admitted as an observation
patient, admitted to the facility as an inpatient, or transferred to another facility as
deemed necessary by the physician.
✔✔Ethnicity - ✔✔A social group that shares a common and distinctive culture, religion,
language or the like.
✔✔Exclusions - ✔✔Certain procedures are excluded from the plan. Asking the
insurance company will let you know what services are not included and covered in the
plan.
✔✔Fair Debt Collection Practices Act (FDCPA) - ✔✔Federal law prohibiting debt
collectors from using unfair, abusive or deceptive practices while attempting to collect
from a consumer.
✔✔False Claims Act - ✔✔Federal law targets fraud against the government.
"Whistleblower's"/qui tam provision allows non-government individuals to "blow the
whistle" in good faith on fraud against the government who may receive up to 30
percent of any recovered damages.
✔✔HCAHPS - ✔✔Also 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.
✔✔Health Exchange - ✔✔Health Insurance Marketplace or "Exchange" —
organizations that facilitate structured and competitive markets for purchasing health
coverage.
✔✔Health Information Technology for Economic and Clinical Health Act of 2009
(HITECH) - ✔✔Federal law stimulating the adoption of electronic health records and
providing financial incentives for demonstrating meaningful use; also expanded HIPAA
security and privacy rules and increased penalties; established data breach notification
rules. HITECH added data breach notification rules and increased penalties and fines to
ensure that any EHR technology created under HITECH does not compromise the
HIPAA security and privacy laws.
✔✔Health Insurance Portability and Accountability Act of 1996 (HIPAA) - ✔✔Originally
focused on regulations related to health insurance portability; focused on administration
simplification and reduction of cost through the protection and standardization of
electronic and financial records. Most known for the privacy rule and security rule, these
rules defined standards for healthcare and protected healthcare information (PHI).
, ✔✔Healthcare Facilities Accreditation Program (HFAP) - ✔✔An accrediting organization
tied to Medicare Conditions of Participation Coverages.
✔✔HITECH Omnibus of 2013 - ✔✔This update to the HITECH Act revised provisions
that focused on an individual's right to request restrictions on the disclosure of PHI
(restricted disclosure) and on an individual's right to access his or her PHI stored in an
EHR.
✔✔Hospice - ✔✔A non-profit organization dedicated to patients and families facing
serious illness or death. Hospice provides a support system to patients and families who
choose to share their last days together in the comfort of their home or hospice
designated facility. Hospice provides a wide range of services that include: coordination
of care with the patient's primary care physician, skilled nursing visits, spiritual
counseling and social worker support. The hospice staff are an interdisciplinary team
who coordinate an individualized plan of care for each patient that is directed by the
Primary Care Physician. Hospice care is a covered service under the Medicare
program.
✔✔Icon - ✔✔A graphic symbol for an application, file or folder.
✔✔Important Message from Medicare (IMM) - ✔✔IMM is a form given to all Medicare
beneficiaries who are inpatients in participating hospitals explaining their rights and
what to do if they feel they are being discharged early.
It explains:
-Rights as hospital patients, including the right to all the hospital care needed and
follow-up care after discharge
-Advises beneficiaries about what to do if they feel they are being discharged early and
provides the phone number for the PRO (Peer Review Organization). Beneficiaries may
remain in the hospital without being charged while the case is being reviewed. Hospitals
cannot force beneficiaries to leave while their case is being reviewed.
✔✔Insurance eligibility - ✔✔The person entitled to benefits and is covered. The date
they became eligible for the plan is important to know since information can change
from month to month along with the termination date of coverage.
✔✔Level of Service - ✔✔The type of care a patient need for their stay. There are three
levels of service: Intensive Care (ICU), step down, floor, observation and outpatient.
✔✔Lifetime Maximum - ✔✔What is their 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.
