CHAA Exam Study Questions &
Answers | 80 Questions with
100% Correct Answers | Updated
& Verified 2024
Accepting Assignment *ans*✨When 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 *ans*✨The patient's ability to obtain medical care. The ease of access is
determined by such components as the availability to the patient, the location of
health care facilities. transportation, hours of operation and cost of care.
Account Number *ans*✨A number assigned to each account. This number is
used to identify the account and all charges and payments received.
Acute Care *ans*✨Medical 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
general short-term rather than long-term or chronic care.
Acute Inpatient Care *ans*✨A level of healthcare delivered to patients
experiencing acute illness or trauma. Acute care is generally short-term (< 30
days)
Add-Ons *ans*✨Patients who are schedules for services less than 24 hours in
advance of the actual service time.
Adjustor *ans*✨Insurance company representative.
Administrative Costs *ans*✨Costs associated with creating and submitting a bill
for services, which could include: registration, utilization review, coding, billing,
and collection expenses.
Admission Authorization *ans*✨The process of third party payor notification of
urgent/emergent inpatient admission with in specified time as determined by the
payors (usually 24-48 hours or next business day).
Admission Date *ans*✨The first date the patient entered the hospital for a
specific visit.
Admitting Diagnosis *ans*✨Word, phrase, of International Classification of
Disease (ICD9) code used by the admitting physician to identify a condition or
disease from which the patient suffers and for which the patient needs or seeks
medical care.
Admitting Physician *ans*✨The physician who writes the order for the patient to
be admitted to the hospital. This physician must have admitting privileges at the
facility providing the healthcare services.
,Advance Beneficiary Notice (ABN) *ans*✨A 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 pay not pay for them.
Advance Directive *ans*✨An advance directive is a written instruction relating to
the provision of healthcare when a patient is incapacitated.
Adverse Selection *ans*✨Among 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 *ans*✨A name by which the patient is also "known as", or formally known
as.
All Patient Diagnosis Related Groups Assignment of Benefits (APDRG) *ans*✨A
prospective hospital claims reimbursement system currently utilized by the
federal government Medicaid program and the states of New York and New
Jersey. APDRG's were designed to describe the complete cross section of patients
seen in acute care hospitals. Approximately 639 APDRG's are defined according
to the principal diagnosis, secondary diagnoses, procedures, age, birth weight,
sex, discharge status.
Alphanumeric *ans*✨Letters, numbers, punctuation marks and mathematical
symbols, as opposed to "numeric" which is numbers only. Term typically related
to the kind of data accepted in a computer field or in coding.
Ambulatory Care Patient *ans*✨Patient receives medical or surgical care in an
outpatient setting that involves a broader, less specialized range of care.
Ambulatory patient are generally able to walk and are not confined to a bed. In a
hospital setting, ambulatory care generally refers to healthcare services provided
on an outpatient basis.
Ambulatory Payment Classification (APC) *ans*✨A system of averaging and
bundling using Current Procedural Terminology (CPT) procedure codes,
Healthcare Common Procedure Coding System (HCPCS) Level II, and revenue
codes submitted for payment. The APC system utilizes groups of CPT codes
based on clinical and resource similarity and establishes payment rates for each
APC grouping.
Ambulatory Surgical Center *ans*✨A freestanding facility, other than a
physician's office, where surgical, diagnostic, and therapeutic services are
provided on an outpatient ambulatory basis.
Ancillary Services *ans*✨A unit of the hospital, other than a nursing unit, which
provides medical services such as diagnostic testing, therapeutic procedures, or
dispenses medical products, such as medications or medical/surgical supplies.
Annual Maximum Benefit Amount Deductible *ans*✨The maximum dollar
amount set by a Managed Care Organization (MCO) that limits the total amount
the plan must pay for all health care services provided to a subscriber in a year.
A deductible is the set amount, per benefit year or period, the third party payor
designates as the patient/guarantors responsibility. Usually the deductible must
be paid before the benefits will be paid by the payor.
, Appeal *ans*✨An appeal is a special kind of complaint made when a beneficiary
or provider disagrees with decisions about health care services - typically related
to payment issues. There is usually a special process used to appeal payor
decisions.
Appropriate Care *ans*✨A diagnostic or treatment measure whose expected
health benefits exceed its expected health risks by a wide enough margin to
justify the measure.
Assignment of Benefits *ans*✨Written authorization from the policyholder for
their insurance company to pay benefits directly to the care provider. Normally
acquired at the time of admission or registration.
Attending Physician *ans*✨The physician who writes outpatient orders for tests,
or supervises the patient's care during an inpatient stay.
Authorization *ans*✨Approval obtained from an insurance carrier for a service
that represents an agreement for payment.
Authorization to Release Medical Information *ans*✨The form authorizing to
release information from the medical records to doctors, hospitals, insurance,
other agencies, etc.
Average Daily Census *ans*✨The average number of inpatient maintained in the
hospital for each day for a specific period of time.
Average Length of Stay *ans*✨The average number of days of service rendered
to each patient during a specific time period.
Bad Debt *ans*✨An accounts receivable that is regarded as uncollectible and is
charged as a credit loss even though the patient has the ability to pay.
Balance Billing *ans*✨The practice of billing a patient for the fee amount
remaining after the insurer payment and co-payment have been made.
Batch Processing *ans*✨Information technology term referring to grouping
similar input items and then processing them together during a single machine
run.
Behavioral Health *ans*✨Assessment and treatment of mental and/or
psychoactive substance abuse disorders.
Beneficiary *ans*✨Person designated to receive the proceeds of an insurance
policy; the insured under a health insurance policy. Also referred to as eligible;
enrollee; or member. Any person eligible as either a subscriber or a dependent
for a managed care service in accordance with a contract.
Benefit Period *ans*✨The number of days that Medicare covers care in hospitals
and skilled nursing facilities are measured in benefit periods. A benefit period
begins on the first day of services of a patient in a hospital or skilled nursing
facility and ends 60 days after discharge from the hospital or skilled facility if 60
days has not been interrupted by skilled care in any other facility.
Benefit Verification Period *ans*✨A benefit period begins on the day of
admission to a hospital of skilled nursing facility and ends when the beneficiary
has not received hospital or skilled nursing care for 60 days in a row. After the 60
Answers | 80 Questions with
100% Correct Answers | Updated
& Verified 2024
Accepting Assignment *ans*✨When 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 *ans*✨The patient's ability to obtain medical care. The ease of access is
determined by such components as the availability to the patient, the location of
health care facilities. transportation, hours of operation and cost of care.
Account Number *ans*✨A number assigned to each account. This number is
used to identify the account and all charges and payments received.
Acute Care *ans*✨Medical 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
general short-term rather than long-term or chronic care.
Acute Inpatient Care *ans*✨A level of healthcare delivered to patients
experiencing acute illness or trauma. Acute care is generally short-term (< 30
days)
Add-Ons *ans*✨Patients who are schedules for services less than 24 hours in
advance of the actual service time.
Adjustor *ans*✨Insurance company representative.
Administrative Costs *ans*✨Costs associated with creating and submitting a bill
for services, which could include: registration, utilization review, coding, billing,
and collection expenses.
Admission Authorization *ans*✨The process of third party payor notification of
urgent/emergent inpatient admission with in specified time as determined by the
payors (usually 24-48 hours or next business day).
Admission Date *ans*✨The first date the patient entered the hospital for a
specific visit.
Admitting Diagnosis *ans*✨Word, phrase, of International Classification of
Disease (ICD9) code used by the admitting physician to identify a condition or
disease from which the patient suffers and for which the patient needs or seeks
medical care.
Admitting Physician *ans*✨The physician who writes the order for the patient to
be admitted to the hospital. This physician must have admitting privileges at the
facility providing the healthcare services.
,Advance Beneficiary Notice (ABN) *ans*✨A 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 pay not pay for them.
Advance Directive *ans*✨An advance directive is a written instruction relating to
the provision of healthcare when a patient is incapacitated.
Adverse Selection *ans*✨Among 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 *ans*✨A name by which the patient is also "known as", or formally known
as.
All Patient Diagnosis Related Groups Assignment of Benefits (APDRG) *ans*✨A
prospective hospital claims reimbursement system currently utilized by the
federal government Medicaid program and the states of New York and New
Jersey. APDRG's were designed to describe the complete cross section of patients
seen in acute care hospitals. Approximately 639 APDRG's are defined according
to the principal diagnosis, secondary diagnoses, procedures, age, birth weight,
sex, discharge status.
Alphanumeric *ans*✨Letters, numbers, punctuation marks and mathematical
symbols, as opposed to "numeric" which is numbers only. Term typically related
to the kind of data accepted in a computer field or in coding.
Ambulatory Care Patient *ans*✨Patient receives medical or surgical care in an
outpatient setting that involves a broader, less specialized range of care.
Ambulatory patient are generally able to walk and are not confined to a bed. In a
hospital setting, ambulatory care generally refers to healthcare services provided
on an outpatient basis.
Ambulatory Payment Classification (APC) *ans*✨A system of averaging and
bundling using Current Procedural Terminology (CPT) procedure codes,
Healthcare Common Procedure Coding System (HCPCS) Level II, and revenue
codes submitted for payment. The APC system utilizes groups of CPT codes
based on clinical and resource similarity and establishes payment rates for each
APC grouping.
Ambulatory Surgical Center *ans*✨A freestanding facility, other than a
physician's office, where surgical, diagnostic, and therapeutic services are
provided on an outpatient ambulatory basis.
Ancillary Services *ans*✨A unit of the hospital, other than a nursing unit, which
provides medical services such as diagnostic testing, therapeutic procedures, or
dispenses medical products, such as medications or medical/surgical supplies.
Annual Maximum Benefit Amount Deductible *ans*✨The maximum dollar
amount set by a Managed Care Organization (MCO) that limits the total amount
the plan must pay for all health care services provided to a subscriber in a year.
A deductible is the set amount, per benefit year or period, the third party payor
designates as the patient/guarantors responsibility. Usually the deductible must
be paid before the benefits will be paid by the payor.
, Appeal *ans*✨An appeal is a special kind of complaint made when a beneficiary
or provider disagrees with decisions about health care services - typically related
to payment issues. There is usually a special process used to appeal payor
decisions.
Appropriate Care *ans*✨A diagnostic or treatment measure whose expected
health benefits exceed its expected health risks by a wide enough margin to
justify the measure.
Assignment of Benefits *ans*✨Written authorization from the policyholder for
their insurance company to pay benefits directly to the care provider. Normally
acquired at the time of admission or registration.
Attending Physician *ans*✨The physician who writes outpatient orders for tests,
or supervises the patient's care during an inpatient stay.
Authorization *ans*✨Approval obtained from an insurance carrier for a service
that represents an agreement for payment.
Authorization to Release Medical Information *ans*✨The form authorizing to
release information from the medical records to doctors, hospitals, insurance,
other agencies, etc.
Average Daily Census *ans*✨The average number of inpatient maintained in the
hospital for each day for a specific period of time.
Average Length of Stay *ans*✨The average number of days of service rendered
to each patient during a specific time period.
Bad Debt *ans*✨An accounts receivable that is regarded as uncollectible and is
charged as a credit loss even though the patient has the ability to pay.
Balance Billing *ans*✨The practice of billing a patient for the fee amount
remaining after the insurer payment and co-payment have been made.
Batch Processing *ans*✨Information technology term referring to grouping
similar input items and then processing them together during a single machine
run.
Behavioral Health *ans*✨Assessment and treatment of mental and/or
psychoactive substance abuse disorders.
Beneficiary *ans*✨Person designated to receive the proceeds of an insurance
policy; the insured under a health insurance policy. Also referred to as eligible;
enrollee; or member. Any person eligible as either a subscriber or a dependent
for a managed care service in accordance with a contract.
Benefit Period *ans*✨The number of days that Medicare covers care in hospitals
and skilled nursing facilities are measured in benefit periods. A benefit period
begins on the first day of services of a patient in a hospital or skilled nursing
facility and ends 60 days after discharge from the hospital or skilled facility if 60
days has not been interrupted by skilled care in any other facility.
Benefit Verification Period *ans*✨A benefit period begins on the day of
admission to a hospital of skilled nursing facility and ends when the beneficiary
has not received hospital or skilled nursing care for 60 days in a row. After the 60
