CHAA 2023 Study Guide/ 182 Questions
with correct Answers.
A financial counselor/Financial Assistance - - In accordance with Section 501(r)
regulations through the Affordable Care Act, a hospital must establish a written
financial assistance policy and make it available to patients.
-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
-A Valid Physician Order - - Legibility Patient name Date (must be within specified
timeline - 30 days or as defined by state statute and/or facility policy) Test or therapy
ordered Diagnosis, signs or symptoms Physician signature
-Patient Contact Center - - A central point in an organization from which all customer
contacts are managed, including scheduling, pre-registration, pre-verification, prior
authorization, functions, etc.
-Pricing Transparency - - In healthcare, readily available information on the price of
healthcare services that, together with other information, helps define the value of those
services and enables patients and other care purchasers to identify, compare and choose
providers that offer the desired level of value.
-Propensity to Pay - - A means to evaluate payment risk, determine the most
appropriate collection policy and initiate financial counseling discussions. Based on a
scoring algorithm, programs can predict likelihood of payment. Those with a history of
bad debt can be adjusted or forwarded to collections at the earliest point possible
,-Access Keys - - NAHAM has developed a series of guidelines that identify performance
criteria, explain how to measure them and provide Good/Better/Best benchmarks for
facilities to measure. These are called:
-Ambulatory Payment Classifications (APCs) - - "Codes billed for outpatient services
preformed at a hospital. is calculated based on the national average cost (operating and
capital) of the hospitals"
-Authorization - - means a determination required under a health benefits plan, which
based on the information provided, satisfies the requirements under the member's
health benefits plan for medical necessity
-Benefits for Automated Quality Assurance - - 100% of registration audited, patients
access associated receive feedback on errors and can self correct, Errors corrected
earlier in the revenue cycle, and clean data before the bill drops.
-BIRTHDAY RULE - - According to the birthday rule, the primary plan for a child is the
health plan of the parent whose birthday comes first in the calendar year. Remember
this is the date, not the year. If both birthdays fall on the same day, then the plan that
has been in effect longer is primary.
-CMS 1450 (UB-04) (UB-92) - - a federal directive requiring a hospital to follow specific
billing procedures, itemizing all services included and billed for on each invoice. Use by
hospitals, skilled nursing facilities, home health agencies, community mental health
facilities,
-Minimum Necessary Standard - - people should only access, use or disclose the health
information that is minimally necessary to accomplish a given task or purpose.
, -Coordination of benefits (COB) - - is a way of determining the order in which benefits
are paid, and the amounts that are payable, when a patient is covered by more than one
health plan.
-(HCAHPS) Hospital Consumer Assessment of Healthcare Providers - - 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.
-Co-pay - - Is used by physicians and other clinicians. It is a fixed amount that the
beneficiary pays for healthcare services, regardless of the actual charge; the amount is
designated by an insurer as the patient's responsibility.
-Critical Data Elements (CDEs) - - Commonly entered errors
-Current Procedural Terminology (CPT) - - codes, which are used for coding procedures
is used to classify services provided by physicians, hospitals and ambulatory surgery
centers
-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.
-Financial counseling/Financial investigation - - Is a method through which the
provider identifies actual payment sources and alternatives for the patient to pay the bill
-Form locator - - is the name of the data fields on each of the uniform bills (i.e., UB-04).
The UB-04 has 81 numerically sequenced form locators, while the 1500 has 33 form
locators.
with correct Answers.
A financial counselor/Financial Assistance - - In accordance with Section 501(r)
regulations through the Affordable Care Act, a hospital must establish a written
financial assistance policy and make it available to patients.
-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
-A Valid Physician Order - - Legibility Patient name Date (must be within specified
timeline - 30 days or as defined by state statute and/or facility policy) Test or therapy
ordered Diagnosis, signs or symptoms Physician signature
-Patient Contact Center - - A central point in an organization from which all customer
contacts are managed, including scheduling, pre-registration, pre-verification, prior
authorization, functions, etc.
-Pricing Transparency - - In healthcare, readily available information on the price of
healthcare services that, together with other information, helps define the value of those
services and enables patients and other care purchasers to identify, compare and choose
providers that offer the desired level of value.
-Propensity to Pay - - A means to evaluate payment risk, determine the most
appropriate collection policy and initiate financial counseling discussions. Based on a
scoring algorithm, programs can predict likelihood of payment. Those with a history of
bad debt can be adjusted or forwarded to collections at the earliest point possible
,-Access Keys - - NAHAM has developed a series of guidelines that identify performance
criteria, explain how to measure them and provide Good/Better/Best benchmarks for
facilities to measure. These are called:
-Ambulatory Payment Classifications (APCs) - - "Codes billed for outpatient services
preformed at a hospital. is calculated based on the national average cost (operating and
capital) of the hospitals"
-Authorization - - means a determination required under a health benefits plan, which
based on the information provided, satisfies the requirements under the member's
health benefits plan for medical necessity
-Benefits for Automated Quality Assurance - - 100% of registration audited, patients
access associated receive feedback on errors and can self correct, Errors corrected
earlier in the revenue cycle, and clean data before the bill drops.
-BIRTHDAY RULE - - According to the birthday rule, the primary plan for a child is the
health plan of the parent whose birthday comes first in the calendar year. Remember
this is the date, not the year. If both birthdays fall on the same day, then the plan that
has been in effect longer is primary.
-CMS 1450 (UB-04) (UB-92) - - a federal directive requiring a hospital to follow specific
billing procedures, itemizing all services included and billed for on each invoice. Use by
hospitals, skilled nursing facilities, home health agencies, community mental health
facilities,
-Minimum Necessary Standard - - people should only access, use or disclose the health
information that is minimally necessary to accomplish a given task or purpose.
, -Coordination of benefits (COB) - - is a way of determining the order in which benefits
are paid, and the amounts that are payable, when a patient is covered by more than one
health plan.
-(HCAHPS) Hospital Consumer Assessment of Healthcare Providers - - 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.
-Co-pay - - Is used by physicians and other clinicians. It is a fixed amount that the
beneficiary pays for healthcare services, regardless of the actual charge; the amount is
designated by an insurer as the patient's responsibility.
-Critical Data Elements (CDEs) - - Commonly entered errors
-Current Procedural Terminology (CPT) - - codes, which are used for coding procedures
is used to classify services provided by physicians, hospitals and ambulatory surgery
centers
-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.
-Financial counseling/Financial investigation - - Is a method through which the
provider identifies actual payment sources and alternatives for the patient to pay the bill
-Form locator - - is the name of the data fields on each of the uniform bills (i.e., UB-04).
The UB-04 has 81 numerically sequenced form locators, while the 1500 has 33 form
locators.
