CHAM || 100% VERIFIED SOLUTIONS.
Accepting Assignment correct answers 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 correct answers The patient's ability to obtain medical care. The ease is determined by
such components as the availability of medical services and their acceptability to the patient, the
location of health-care facilities, transportation, hours of operation and cost of care.
Account Number correct answers A number assigned to each account. This number is used to
identify the account and all charges and payments received.
Acute Care correct answers 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. This care is generally short-term rather than long-term or
chronic care.
Acute Impatient Care correct answers A level of healthcare delivered to patients experiencing
acute illness or trauma. Generally short-term (<30 days).
Add Ons correct answers Patients who are scheduled for services less than 24 hours in advance
of the actual service time.
Adjustor correct answers Insurance company representative.
Administrative Costs correct answers Costs associated with creating and submitting a bill for
services, which could include: registration, utilization review, coding, billing, and collection
expenses.
,Admission Authorization correct answers The process of third-party payer notification of
urgent/emergent inpatient admission within specified time as determined by payers (usually 24-
48 hours or next business day).
Admission Date correct answers The first date the patient entered the hospital for a specific visit.
Admitting Diagnosis correct answers Word, phrase, or International Classification of Disease
(ICD10) code used by the admitting physician to identify a condition or disease from which a
patient suffers and for which the patient needs or seeks medical care.
Admitting Physician correct answers The physician who writes the order for the patient to be
admitted to the hospital. The physician must have admitting privileges at the facility providing
the healthcare services.
Advance Beneficiary Notice correct answers 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 may not pay for them. Allows the beneficiary to make an informed
decision prior to services regarding whether or not they wish to receive services. Are not
routinely given to emergency department patients.
Advance Directive correct answers A written instruction relating to the provision of healthcare
when a patient is incapacitated. It could include appointing someone to make medical decisions,
a statement expressing the patient's wishes about anatomical gifts (i.e. organ donation) and
general statements about whether or not life sustaining treatments should be withheld or
withdrawn.
Adverse Selection correct answers 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 number and lower deductibles.
Alias correct answers A name by which the patient is also "known as", or formerly known as.
All Patient Diagnosis Related Groups Assignment of Benefits (APDRG) correct answers A
prospective hospital claims reimbursement system currently utilized by the federal government
,Medicaid program and the states of New York and New Jersey. Designed to describe the
complete cross section of patients seen in acute care hospitals. Approximately 639 are defined
according to the principal diagnosis, secondary diagnoses, procedures, age, birth weight, sex and
discharge status. Each category has an established fixed reimbursement rate based on average
cost of treatment within a geographic area. Were developed to quantify the difference in
demographic groups and clinical risk factors for patients treated in hospitals. This proprietary
grouping system's (i.e. 3M) purpose is to obtain fair and accurate statistical comparisons between
disparate populations and groups. Unlike the Diagnosis Related Group (DRG) reimbursement
system, which is intended to capture resource utilization intensity, this system captures and
relates the severity of illness and risk of mortality factors present as a result of a patient's disease
and disorders and the interaction of those disorders. A form is signed by the patient giving the
healthcare provider authority to bill his/her insurance plan and receive payment. The form is
generally presented and signed at the time of registration.
Alphanumeric correct answers 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 correct answers Patient receives medical or surgical care in an
outpatient setting that involves a broader, less specialized range of care. Ambulatory patients 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) correct answers 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 ______
system utilizes groups of CPT codes based on clinical and resource similarity and establishes
payment rates for each ______ grouping. The 650+ ______ are divided by significant
procedures, medical services, ancillary services and partial hospitalization services. The ______
are similar clinically, by resources uses and cost.
Ambulatory Surgical Center correct answers A freestanding facility, other than a physician's
office, where surgical, diagnostic, and therapeutic services are provided on an outpatient
ambulatory basis.
Ancillary Services correct answers A unit of the hospital, other than a nursing unit, that provides
medical services such as diagnostic testing and therapeutic procedures, or dispenses medical
, products, such as medications or medical/surgical supplies. Examples: Laboratory, Medical
Imaging, Physical Therapy and Pharmacy. Ancillary is used to describe diagnostic or therapeutic
services, such as laboratory, radiology, pharmacy, or physical therapy, performed by departments
that do not have inpatient beds.
Annual Maximum Benefit Amount Deductible correct answers 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, that the third party payer designates as
the patient/guarantors responsibility. Usually the deductible must be paid before the benefits will
be paid by the payer.
Appeal correct answers A special kind of complaint made when a beneficiary or provider
disagrees with decisions about healthcare services-typically related to payment issues. There is
usually a special process used to appeal payer decisions.
Appropriate Care correct answers 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 Benefit correct answers 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 correct answers The physician who writes outpatient orders for tests, or
supervises the patient's care during an inpatient stay.
Authorization correct answers Approval obtained from an insurance carrier for a service that
represents an agreement for payment.
Authorization to Release Medical Information correct answers The form authorizing to release
information from the medical records to doctors, hospitals, insurance, other agencies, etc.
Accepting Assignment correct answers 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 correct answers The patient's ability to obtain medical care. The ease is determined by
such components as the availability of medical services and their acceptability to the patient, the
location of health-care facilities, transportation, hours of operation and cost of care.
Account Number correct answers A number assigned to each account. This number is used to
identify the account and all charges and payments received.
Acute Care correct answers 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. This care is generally short-term rather than long-term or
chronic care.
Acute Impatient Care correct answers A level of healthcare delivered to patients experiencing
acute illness or trauma. Generally short-term (<30 days).
Add Ons correct answers Patients who are scheduled for services less than 24 hours in advance
of the actual service time.
Adjustor correct answers Insurance company representative.
Administrative Costs correct answers Costs associated with creating and submitting a bill for
services, which could include: registration, utilization review, coding, billing, and collection
expenses.
,Admission Authorization correct answers The process of third-party payer notification of
urgent/emergent inpatient admission within specified time as determined by payers (usually 24-
48 hours or next business day).
Admission Date correct answers The first date the patient entered the hospital for a specific visit.
Admitting Diagnosis correct answers Word, phrase, or International Classification of Disease
(ICD10) code used by the admitting physician to identify a condition or disease from which a
patient suffers and for which the patient needs or seeks medical care.
Admitting Physician correct answers The physician who writes the order for the patient to be
admitted to the hospital. The physician must have admitting privileges at the facility providing
the healthcare services.
Advance Beneficiary Notice correct answers 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 may not pay for them. Allows the beneficiary to make an informed
decision prior to services regarding whether or not they wish to receive services. Are not
routinely given to emergency department patients.
Advance Directive correct answers A written instruction relating to the provision of healthcare
when a patient is incapacitated. It could include appointing someone to make medical decisions,
a statement expressing the patient's wishes about anatomical gifts (i.e. organ donation) and
general statements about whether or not life sustaining treatments should be withheld or
withdrawn.
Adverse Selection correct answers 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 number and lower deductibles.
Alias correct answers A name by which the patient is also "known as", or formerly known as.
All Patient Diagnosis Related Groups Assignment of Benefits (APDRG) correct answers A
prospective hospital claims reimbursement system currently utilized by the federal government
,Medicaid program and the states of New York and New Jersey. Designed to describe the
complete cross section of patients seen in acute care hospitals. Approximately 639 are defined
according to the principal diagnosis, secondary diagnoses, procedures, age, birth weight, sex and
discharge status. Each category has an established fixed reimbursement rate based on average
cost of treatment within a geographic area. Were developed to quantify the difference in
demographic groups and clinical risk factors for patients treated in hospitals. This proprietary
grouping system's (i.e. 3M) purpose is to obtain fair and accurate statistical comparisons between
disparate populations and groups. Unlike the Diagnosis Related Group (DRG) reimbursement
system, which is intended to capture resource utilization intensity, this system captures and
relates the severity of illness and risk of mortality factors present as a result of a patient's disease
and disorders and the interaction of those disorders. A form is signed by the patient giving the
healthcare provider authority to bill his/her insurance plan and receive payment. The form is
generally presented and signed at the time of registration.
Alphanumeric correct answers 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 correct answers Patient receives medical or surgical care in an
outpatient setting that involves a broader, less specialized range of care. Ambulatory patients 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) correct answers 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 ______
system utilizes groups of CPT codes based on clinical and resource similarity and establishes
payment rates for each ______ grouping. The 650+ ______ are divided by significant
procedures, medical services, ancillary services and partial hospitalization services. The ______
are similar clinically, by resources uses and cost.
Ambulatory Surgical Center correct answers A freestanding facility, other than a physician's
office, where surgical, diagnostic, and therapeutic services are provided on an outpatient
ambulatory basis.
Ancillary Services correct answers A unit of the hospital, other than a nursing unit, that provides
medical services such as diagnostic testing and therapeutic procedures, or dispenses medical
, products, such as medications or medical/surgical supplies. Examples: Laboratory, Medical
Imaging, Physical Therapy and Pharmacy. Ancillary is used to describe diagnostic or therapeutic
services, such as laboratory, radiology, pharmacy, or physical therapy, performed by departments
that do not have inpatient beds.
Annual Maximum Benefit Amount Deductible correct answers 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, that the third party payer designates as
the patient/guarantors responsibility. Usually the deductible must be paid before the benefits will
be paid by the payer.
Appeal correct answers A special kind of complaint made when a beneficiary or provider
disagrees with decisions about healthcare services-typically related to payment issues. There is
usually a special process used to appeal payer decisions.
Appropriate Care correct answers 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 Benefit correct answers 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 correct answers The physician who writes outpatient orders for tests, or
supervises the patient's care during an inpatient stay.
Authorization correct answers Approval obtained from an insurance carrier for a service that
represents an agreement for payment.
Authorization to Release Medical Information correct answers The form authorizing to release
information from the medical records to doctors, hospitals, insurance, other agencies, etc.
