AAHAM EVALUATION EXAM 2025 QUESTIONS ANSD
SOLUTIONS RATED A+
✔✔DEPOSIT COLLECTION PROGRAM COMBINED WITH PRE-REGISTRATION
AND INSURANCE VERIFICATION - ✔✔LEADS TO INCREASED CASH
COLLECTIONS, DECREASED A/R DUE AT DISCHARGE, DECREASED OVERALL
A/R, DECREASED FINANCIAL RISK AND BAD DEBT. INCREASED POSSIBLE
PUBLIC RELATIONS ISSUES.
✔✔AFFILIATED HEALTHCARE SERVICES - ✔✔INCLUDES REFERALLS FOR
PHYSICIANS AND SERVICES, REGISTRATION FOR IN HOUSE SPONSORED
MEDICAL EDUCATION PROGRAMS, TELEPHONE TRIAGE AVAILABLE.
✔✔PHYSICIAN DIRECT SERVICES - ✔✔WORK DIRECTLY WITH PHYSICIANS SO
THEY CAN DELIVER PROFESSIONAL MEDICAL CARE AND OPINIONS.
✔✔CASE MANAGEMENT / UR TASKS - ✔✔REDUCING UNNECESSARY
ADMISSIONS.
MANAGING THE APPROVED LENGTH OF STAY.
ENSURING AN APPROPRIATE LEVEL OF CARE.
SERVING AS LIAISON WITH PRIMARY AND SPEC. PHYSICIANS AND
INSURANCES.
OBTAINING APPROVALS FOR PRE-CERT.
ADVISING PT. OF DISCHARGE, ASSISTING WITH APPEALS FOR DENIALS.
✔✔RESPITE CARE - ✔✔SHORT TERM CUSTODIAL CARE FOR A FAMILY MEMBER
OR UNPAID CAREGIVER TO GET RELIEF FROM A PT. AT HOME.
✔✔OBSERVATION - ✔✔MONITORING IN HOSPITAL LESS THAN 24 HOURS. RARE
IS 48 HOURS.
✔✔OUTPATIENT - ✔✔TREATMENT FOR SOMEONE NOT HOSPITALIZED.
✔✔SNF..... SKILLED NURSING FACILITY - ✔✔NURSING HOME. PT. MUST BE
HOSPITAL INPATIENT FOR 3 DAYS
✔✔HOSPICE CARE - ✔✔CARE FOR DYING PATIENTS AND THEIR FAMILIES.
✔✔CONSENT FORMS - ✔✔SPECIAL; CONSENT FORMS NEEDED FOR
PSYCHIATRIC TREATMENT, HIV POSITIVE TESTING, EXPERIMENTAL.
✔✔MEDICAL RECORDS - ✔✔TREATING PHYSICIANS, ATTENDING, PHYSICIAN
EXTENDER, REGISTERED NURSE, STUDENT WITH OBSERVATION MAY MAKE
ENTRIES.
, WHEN ERRORS HAPPEN, INITIAL IT, LINE THRU IT, CONTINUE.
✔✔ABN. ADVANCED BENEFICIARY NOTICE OF NON COVERAGE. - ✔✔FORM
GIVEN TO MEDICARE BENEFICIARIES BEFORE SERVICES NO MEDICALLY
NECESSARY. COMPLETE DESCRIPTION, PATIENT MUST SIGN AND DATE. ONLY
GIVEN WHEN DOUBT OF PAYMENT.
✔✔LCD, LOCAL COVERAGE DETERMINATION.
NCD, NATIONAL COVERAGE DETERMINATION - ✔✔LOCAL - WHAT IS
REASONABLE, NECESSARY, AND APPROPRIATE
NATIONAL - WHAT IS COVERED BY MEDICARE
✔✔HICN - ✔✔, MEDICARE HEALTH INSURANCE CLAIM NUMBER. ALWAYS
INCLUDES 6 OR 9 DIGITS. HUSBAND OVER 65 IS B1. WIDOWED WIFE IS D.
✔✔MEDIGAP - ✔✔COVERS DEDUCTIBLES, CO-INS, COPAYS
✔✔MEDICARE PART C - ✔✔MEDICARE ADVANTAGE PLUS.
✔✔MEDICARE PART B - ✔✔PAYS OUTPATIENT DOCTOR VISITS, SOME DOCTOR
SERVICES PART A WONT COVER.
PAYS AMBULANCE SERVICES.
MAY GO UP 10% FOR EACH YEAR THEY DID NOT SIGN UP.
REQ. BLOOD DEDUCTIBLE.
✔✔WORKERS COMP. - ✔✔COVERS JOB INJURIES.
✔✔SCHIP - ✔✔STATE CHILDRENS HEALTH INSURANCE PROGRAM. FOR KIDS
WHOS PARENTS ARE NOT ELIGIBLE FOR MEDICAID BUT HAVE NO INSURANCE.
✔✔MEDICARE PART A - ✔✔PAYS MEDICALLY NECESSARY INPATIENT
HOSPITALIZATIONS, CARE IN SKILLED NURSING, HOME HEALTH, HOSPICE, AND
BLOOD. REQ. BLOOD DEDUCTIBLE.
✔✔DUAL ELIGIBLE - ✔✔PATIENTS WHO QUALIFY FOR BOTH PART A AND B.
✔✔TRI-CARE - ✔✔PROGRAM FOR ACTIVE DUTY AND RETIRED AND FAMILIES
REPLACES CHAMPUS
✔✔MEDICARE PART D - ✔✔PRESCRIPTION DRUG COVERAGE.
SOLUTIONS RATED A+
✔✔DEPOSIT COLLECTION PROGRAM COMBINED WITH PRE-REGISTRATION
AND INSURANCE VERIFICATION - ✔✔LEADS TO INCREASED CASH
COLLECTIONS, DECREASED A/R DUE AT DISCHARGE, DECREASED OVERALL
A/R, DECREASED FINANCIAL RISK AND BAD DEBT. INCREASED POSSIBLE
PUBLIC RELATIONS ISSUES.
✔✔AFFILIATED HEALTHCARE SERVICES - ✔✔INCLUDES REFERALLS FOR
PHYSICIANS AND SERVICES, REGISTRATION FOR IN HOUSE SPONSORED
MEDICAL EDUCATION PROGRAMS, TELEPHONE TRIAGE AVAILABLE.
✔✔PHYSICIAN DIRECT SERVICES - ✔✔WORK DIRECTLY WITH PHYSICIANS SO
THEY CAN DELIVER PROFESSIONAL MEDICAL CARE AND OPINIONS.
✔✔CASE MANAGEMENT / UR TASKS - ✔✔REDUCING UNNECESSARY
ADMISSIONS.
MANAGING THE APPROVED LENGTH OF STAY.
ENSURING AN APPROPRIATE LEVEL OF CARE.
SERVING AS LIAISON WITH PRIMARY AND SPEC. PHYSICIANS AND
INSURANCES.
OBTAINING APPROVALS FOR PRE-CERT.
ADVISING PT. OF DISCHARGE, ASSISTING WITH APPEALS FOR DENIALS.
✔✔RESPITE CARE - ✔✔SHORT TERM CUSTODIAL CARE FOR A FAMILY MEMBER
OR UNPAID CAREGIVER TO GET RELIEF FROM A PT. AT HOME.
✔✔OBSERVATION - ✔✔MONITORING IN HOSPITAL LESS THAN 24 HOURS. RARE
IS 48 HOURS.
✔✔OUTPATIENT - ✔✔TREATMENT FOR SOMEONE NOT HOSPITALIZED.
✔✔SNF..... SKILLED NURSING FACILITY - ✔✔NURSING HOME. PT. MUST BE
HOSPITAL INPATIENT FOR 3 DAYS
✔✔HOSPICE CARE - ✔✔CARE FOR DYING PATIENTS AND THEIR FAMILIES.
✔✔CONSENT FORMS - ✔✔SPECIAL; CONSENT FORMS NEEDED FOR
PSYCHIATRIC TREATMENT, HIV POSITIVE TESTING, EXPERIMENTAL.
✔✔MEDICAL RECORDS - ✔✔TREATING PHYSICIANS, ATTENDING, PHYSICIAN
EXTENDER, REGISTERED NURSE, STUDENT WITH OBSERVATION MAY MAKE
ENTRIES.
, WHEN ERRORS HAPPEN, INITIAL IT, LINE THRU IT, CONTINUE.
✔✔ABN. ADVANCED BENEFICIARY NOTICE OF NON COVERAGE. - ✔✔FORM
GIVEN TO MEDICARE BENEFICIARIES BEFORE SERVICES NO MEDICALLY
NECESSARY. COMPLETE DESCRIPTION, PATIENT MUST SIGN AND DATE. ONLY
GIVEN WHEN DOUBT OF PAYMENT.
✔✔LCD, LOCAL COVERAGE DETERMINATION.
NCD, NATIONAL COVERAGE DETERMINATION - ✔✔LOCAL - WHAT IS
REASONABLE, NECESSARY, AND APPROPRIATE
NATIONAL - WHAT IS COVERED BY MEDICARE
✔✔HICN - ✔✔, MEDICARE HEALTH INSURANCE CLAIM NUMBER. ALWAYS
INCLUDES 6 OR 9 DIGITS. HUSBAND OVER 65 IS B1. WIDOWED WIFE IS D.
✔✔MEDIGAP - ✔✔COVERS DEDUCTIBLES, CO-INS, COPAYS
✔✔MEDICARE PART C - ✔✔MEDICARE ADVANTAGE PLUS.
✔✔MEDICARE PART B - ✔✔PAYS OUTPATIENT DOCTOR VISITS, SOME DOCTOR
SERVICES PART A WONT COVER.
PAYS AMBULANCE SERVICES.
MAY GO UP 10% FOR EACH YEAR THEY DID NOT SIGN UP.
REQ. BLOOD DEDUCTIBLE.
✔✔WORKERS COMP. - ✔✔COVERS JOB INJURIES.
✔✔SCHIP - ✔✔STATE CHILDRENS HEALTH INSURANCE PROGRAM. FOR KIDS
WHOS PARENTS ARE NOT ELIGIBLE FOR MEDICAID BUT HAVE NO INSURANCE.
✔✔MEDICARE PART A - ✔✔PAYS MEDICALLY NECESSARY INPATIENT
HOSPITALIZATIONS, CARE IN SKILLED NURSING, HOME HEALTH, HOSPICE, AND
BLOOD. REQ. BLOOD DEDUCTIBLE.
✔✔DUAL ELIGIBLE - ✔✔PATIENTS WHO QUALIFY FOR BOTH PART A AND B.
✔✔TRI-CARE - ✔✔PROGRAM FOR ACTIVE DUTY AND RETIRED AND FAMILIES
REPLACES CHAMPUS
✔✔MEDICARE PART D - ✔✔PRESCRIPTION DRUG COVERAGE.
