ACMA CERTIFICATION REVIEW EXAMS SCRIPT
QUESTIONS AND ANSWERS SURE A+
✔✔Informed consent - ✔✔Aimed at creating a mutual understanding between patient
and the provider about the care, treatment, and services that may be provided. Process
enables patient to actively participate in care and treatment decisions and to understand
the risks, benefits, options, and alternative. All patients have this right
✔✔Inpatient - ✔✔Hospital status for patients formally admitted to a hospital with a MD
order and formal admission by hospital that is based on MD judgment and medical
necessity. Two midnight rule applies
✔✔Inpatient Rehabilitation Facility (IRF/IPR) or Acute Rehabiliation - ✔✔Facility with
level of care where patients must have had a recent event altering functional abilities,
have strength and endurance to participate in 3 hours of therapy per day, and have the
cognitive ability to participate progressively
✔✔Instrumental Activities of Daily Living (IADLs) - ✔✔"Second level" activities that
support an independent lifestyle. Includes: cooking, driving, using phone or computer,
shopping, managing finances or medications, meal prep, etc.
✔✔Justice - ✔✔moral obligation to act on the basis of fair adjudication between
competing claims or a group of norms pertaining to balancing benefits against risks and
costs. Value of fairness
, ✔✔Length of Stay (LOS) - ✔✔Refers to the number of days that a patient stays in an
inpatient facility during a single episode of hospitalization. Days of stay in a hospital as
inpatient are calculated by subtracting the day of admission from day of discharge.
Same day inpatient admission and discharge counts as 1 day
✔✔Level of Care - ✔✔Intensity of medical care being provided that is classified by the
kind of care given, the number of people services and the people providing the care.
Types of care: Primary, secondary, tertiary depending of these factors
✔✔Long-term Acute Care Hospital (LTACH) - ✔✔Specialized care facility designed to
treat acutely ill patients who benefit from a prolonged LOS for a minimum of 25 days.
Provide longer term acute hospital care
✔✔Long Term Care Insurance Policy - ✔✔Insurance policy designed to cover long term
services and supports including personal and custodial care in a variety of settings such
as home, a community organization, or other facility
✔✔Managed Medicare - ✔✔Managed healthcare that provides a substitute for
original/traditional Medicare parts A/B. Aims to reduce Medicare costs
✔✔Medicaid - ✔✔Joint federal and state program that helps low income individuals or
families pay for the costs associated with long-term medical and custodial care,
provided they qualify.
✔✔Medicaid Integrity Contractors (MIC) - ✔✔Contractor responsible for ensuring that
paid claims were for 1. Services provided and properly documented 2. Services billed
properly using correct and appropriate procedure code, and 3 covered services. Also
that all claims are paid according to federal and state laws, regulations, and policies
✔✔Three types of Medicaid Integrity Contractors (MIC)s - ✔✔Review, audit, and
education
✔✔Medical Necessity Denial - ✔✔A denial of services for the requested treatment of a
member that does not appear to meet medically necessity criteria and cannot be
medically certified based on the information provided by the treating clinician or the
treating clinician's designated representative
✔✔Medicare - ✔✔A national social insurance program that guarantees access to health
insurance for Americans ages 65 and older, younger individuals with disabilities, and
individuals with end-stage renal disease
✔✔Medicare Part A - ✔✔Covers inpatient hospital services under Medicare
✔✔Medicare Part B - ✔✔Covers outpatient services for Medicare
QUESTIONS AND ANSWERS SURE A+
✔✔Informed consent - ✔✔Aimed at creating a mutual understanding between patient
and the provider about the care, treatment, and services that may be provided. Process
enables patient to actively participate in care and treatment decisions and to understand
the risks, benefits, options, and alternative. All patients have this right
✔✔Inpatient - ✔✔Hospital status for patients formally admitted to a hospital with a MD
order and formal admission by hospital that is based on MD judgment and medical
necessity. Two midnight rule applies
✔✔Inpatient Rehabilitation Facility (IRF/IPR) or Acute Rehabiliation - ✔✔Facility with
level of care where patients must have had a recent event altering functional abilities,
have strength and endurance to participate in 3 hours of therapy per day, and have the
cognitive ability to participate progressively
✔✔Instrumental Activities of Daily Living (IADLs) - ✔✔"Second level" activities that
support an independent lifestyle. Includes: cooking, driving, using phone or computer,
shopping, managing finances or medications, meal prep, etc.
✔✔Justice - ✔✔moral obligation to act on the basis of fair adjudication between
competing claims or a group of norms pertaining to balancing benefits against risks and
costs. Value of fairness
, ✔✔Length of Stay (LOS) - ✔✔Refers to the number of days that a patient stays in an
inpatient facility during a single episode of hospitalization. Days of stay in a hospital as
inpatient are calculated by subtracting the day of admission from day of discharge.
Same day inpatient admission and discharge counts as 1 day
✔✔Level of Care - ✔✔Intensity of medical care being provided that is classified by the
kind of care given, the number of people services and the people providing the care.
Types of care: Primary, secondary, tertiary depending of these factors
✔✔Long-term Acute Care Hospital (LTACH) - ✔✔Specialized care facility designed to
treat acutely ill patients who benefit from a prolonged LOS for a minimum of 25 days.
Provide longer term acute hospital care
✔✔Long Term Care Insurance Policy - ✔✔Insurance policy designed to cover long term
services and supports including personal and custodial care in a variety of settings such
as home, a community organization, or other facility
✔✔Managed Medicare - ✔✔Managed healthcare that provides a substitute for
original/traditional Medicare parts A/B. Aims to reduce Medicare costs
✔✔Medicaid - ✔✔Joint federal and state program that helps low income individuals or
families pay for the costs associated with long-term medical and custodial care,
provided they qualify.
✔✔Medicaid Integrity Contractors (MIC) - ✔✔Contractor responsible for ensuring that
paid claims were for 1. Services provided and properly documented 2. Services billed
properly using correct and appropriate procedure code, and 3 covered services. Also
that all claims are paid according to federal and state laws, regulations, and policies
✔✔Three types of Medicaid Integrity Contractors (MIC)s - ✔✔Review, audit, and
education
✔✔Medical Necessity Denial - ✔✔A denial of services for the requested treatment of a
member that does not appear to meet medically necessity criteria and cannot be
medically certified based on the information provided by the treating clinician or the
treating clinician's designated representative
✔✔Medicare - ✔✔A national social insurance program that guarantees access to health
insurance for Americans ages 65 and older, younger individuals with disabilities, and
individuals with end-stage renal disease
✔✔Medicare Part A - ✔✔Covers inpatient hospital services under Medicare
✔✔Medicare Part B - ✔✔Covers outpatient services for Medicare
