ACMA Exam|Complete Questions with A+
Graded Answers
acute care
active and short term treatment for severe injury, illness, or after surgery
adherence/compliance
The degree to which an individual follows a recommended health-related or illness-related
recommendation.
Admission or Initial Review
examine medical necessity for hospital admission and evaluate healthcare services or supplies needed
Acute Inpatient Rehab (AIR)
must have had recent event altering functional abilities, three hours, cognitive abilities to learn
progressively
assent
To agree or concur. Used for minors making healthcare decisions. Minors cannot consent but does
have ability to understand treatment risks and participate in decisions - agreeing with
recommendations
assisted living facility
Supervision or assistance for ADLs. Coordination of outside services, monitoring activities to insure
safety, health, wellbeing. Assistance includes meds and personal care. Emerged in 1990s as
alternative for not needing 24 hour nursing. Promotes independence and dignity.
Beneficence
to do good for others
Bundled Payments
Reimbursement of healthcare providers on basis of expected costs for episodes of care
BPCI
Organizations enter into payment arrangements that include financial and performance
accountability for episode of care
capacity
ability to make independent decisions about treatment. Includes understanding info including risks
and benefits. , express decisions, weigh consequences.
Case Mix Index (CMI)
measurement representing the average diagnosis related group (DRG) relative weight. Calculated by
adding DRG weight of all Medicare discharges and dividing number of discharges
, Centers for Medicare and Medicaid Services (CMS)
a federal agency within the U.S. Department of Health and Human Services that is responsible for
Medicare and Medicaid, among many other responsibilities.
compliance
degree in which patient correctly follows medical advice. Includes medications, self care, therapy recs
Condition Code 44
Medicare only.
When UR committee consults with MD determines that admission is not medically necessary but
observation is appropriate.
Change to obs is permissible if all is met 1)Change is made before discharge 2)hospital has not
submitted a claim for inpatient 3) The MD agrees with decision of UR 4) Documented why change
made in medical record with orders, Pt must be informed.
-If conditions not met, can bill Part B Medicare.
Conditions of Participation (CoP)
Conditions that healthcare organizations must meet in order to participate with Medicare and
Medicaid. UR and DCP.
DCP applies to all patients and hospitals must have a process to identify patients likely to have
adverse events without DCP. DCP assessment must be provided for these patients as well as those
who patients/families/MDs request. Hospitals can choose whether to see everyone or just those at
risk.
Requires detailed discharge instructions be provided to pt and caregiver. Staff must teach back.
Continued Stay Review
Ongoing assessment of patient's progress through review of physician documentation. Determined
whether continued stay should occur or move to another level or care or discharge.
Core measures
key quality indicators that help health care institutions improve performance, increase accountability,
and reduce costs
Detailed Notice of Discharge (DND)
Full explanation for hospital discharge and why services are no longer covered by medicare
Diagnosis-related groups (DRGs)
System that categorizes into payment groups patients who are medically related with respect to
diagnosis and treatment and statistically similar with regard to length of stay
Extended Stay/ Recovery
outpatients in a bed who do not meet inpatient or observation. Room and board not billable
generally.
Graded Answers
acute care
active and short term treatment for severe injury, illness, or after surgery
adherence/compliance
The degree to which an individual follows a recommended health-related or illness-related
recommendation.
Admission or Initial Review
examine medical necessity for hospital admission and evaluate healthcare services or supplies needed
Acute Inpatient Rehab (AIR)
must have had recent event altering functional abilities, three hours, cognitive abilities to learn
progressively
assent
To agree or concur. Used for minors making healthcare decisions. Minors cannot consent but does
have ability to understand treatment risks and participate in decisions - agreeing with
recommendations
assisted living facility
Supervision or assistance for ADLs. Coordination of outside services, monitoring activities to insure
safety, health, wellbeing. Assistance includes meds and personal care. Emerged in 1990s as
alternative for not needing 24 hour nursing. Promotes independence and dignity.
Beneficence
to do good for others
Bundled Payments
Reimbursement of healthcare providers on basis of expected costs for episodes of care
BPCI
Organizations enter into payment arrangements that include financial and performance
accountability for episode of care
capacity
ability to make independent decisions about treatment. Includes understanding info including risks
and benefits. , express decisions, weigh consequences.
Case Mix Index (CMI)
measurement representing the average diagnosis related group (DRG) relative weight. Calculated by
adding DRG weight of all Medicare discharges and dividing number of discharges
, Centers for Medicare and Medicaid Services (CMS)
a federal agency within the U.S. Department of Health and Human Services that is responsible for
Medicare and Medicaid, among many other responsibilities.
compliance
degree in which patient correctly follows medical advice. Includes medications, self care, therapy recs
Condition Code 44
Medicare only.
When UR committee consults with MD determines that admission is not medically necessary but
observation is appropriate.
Change to obs is permissible if all is met 1)Change is made before discharge 2)hospital has not
submitted a claim for inpatient 3) The MD agrees with decision of UR 4) Documented why change
made in medical record with orders, Pt must be informed.
-If conditions not met, can bill Part B Medicare.
Conditions of Participation (CoP)
Conditions that healthcare organizations must meet in order to participate with Medicare and
Medicaid. UR and DCP.
DCP applies to all patients and hospitals must have a process to identify patients likely to have
adverse events without DCP. DCP assessment must be provided for these patients as well as those
who patients/families/MDs request. Hospitals can choose whether to see everyone or just those at
risk.
Requires detailed discharge instructions be provided to pt and caregiver. Staff must teach back.
Continued Stay Review
Ongoing assessment of patient's progress through review of physician documentation. Determined
whether continued stay should occur or move to another level or care or discharge.
Core measures
key quality indicators that help health care institutions improve performance, increase accountability,
and reduce costs
Detailed Notice of Discharge (DND)
Full explanation for hospital discharge and why services are no longer covered by medicare
Diagnosis-related groups (DRGs)
System that categorizes into payment groups patients who are medically related with respect to
diagnosis and treatment and statistically similar with regard to length of stay
Extended Stay/ Recovery
outpatients in a bed who do not meet inpatient or observation. Room and board not billable
generally.
