CHAA Study Guide questions well
answered graded A+ passed
Defined as "a self-assessment and external peer assessment process used by healthcare
organizations to accurately assess their level of performance in relation to established standards
and to implement ways to continuously improve."
Examples include: TJC, Healthcare Accreditation Program, DNVGL
helps organize patient safety efforts, improves risk management, provides education, provides
professional advice, authority for Medicare certification and other third party insurers - correct
answer ✔✔Accreditation
gathering and analyzing data from patient satisfaction surveys to initiate education and
remedial action and then evaluate actions taken. - correct answer ✔✔Quality Improvement
Initiatives
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 generally short-term rather than long-term or chronic care. -
correct answer ✔✔Acute care
A level of healthcare delivered to patients experiencing acute illness or trauma. Is generally
short-term (<30 days). - correct answer ✔✔Acute Inpatient Care
Written notice issued to a fee-for-service (Original Medicare) beneficiary before furnishing items
or services that are usually covered by Medicare but are not expected to be paid in a specific
instance for certain reasons, such as lack of medical necessity. If not given, patient cannot be
billed for service. - correct answer ✔✔Advance Beneficiary Notice (ABN)
,Also known as a medical directive, healthcare directive or a living will, a legal document in
which a person has outlined what they would like to be done if they are no longer able to make
decisions for themselves due to incapacity or illness. - correct answer ✔✔Advance Directive
Patient receives surgical treatment and is discharged from the facility within four to six hours of
procedure. _______ can occur in an outpatient hospital department or in a freestanding
ambulatory care facility. - correct answer ✔✔Ambulatory Services/Same-Day Surgery
Physician refers patients for scheduled and non-scheduled services such as radiology,
laboratory, and/or other services that are performed in a hospital or clinic setting. Patients leave
the facility once the services are completed. - correct answer ✔✔Ancillary Services
Anti-fraud federal criminal statute that prohibits offering or exchange of anything of value in
exchange for healthcare business referrals, including cash, rent, expensive hotel stays, etc. -
correct answer ✔✔Anti-Kickback Statute
Certain services need _____ while other procedures might not. Some insurance companies
require a CPT code, so make sure you have that available. - correct answer ✔✔Authorization
Requirement
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 ______ are not available for users to view until after the _____ is
run. - correct answer ✔✔Batch Processing
A decision to separately purchase a service, which is typically a part of an indemnity of an HMO
plan. For example, an HMO may "_________" the behavioral health benefits and select a
specialized vendor to supply these services on a stand-alone basis. ____________ may also
include medical devices that the plan pays for in addition to the contracted per diem or case
, rate. Pre-certification/pre-authorization is often required for these benefits and services. -
correct answer ✔✔Carve Out
Coordination of services to help meet a patient's healthcare needs. - correct answer ✔✔Case
Management
Federal agency under the Department of Health and Humans Services (HHS) that administers
Medicare and partners with state governments for administration of Medicaid and other
programs, including the Children's Health Insurance Program (CHIP). - correct answer
✔✔Centers for Medicare and Medicaid Services (CMS)
The _______ is an insurance program for the families of veterans who are not eligible for
Tricare. - correct answer ✔✔Civilian Health and Medical Program for the Veterans
Administration (CHAMPVA)
Free or discounted medical care provided to patients who do not have the ability to pay for all
or a part of medical costs due to limited income or financial hardship. - correct answer
✔✔Charity care
The percentage amount that is payable, per policy provisions, toward medical costs after the
deductible has been met. For example, a patient's _________ amount may be 20 percent, and
the insurance company's _________ could be 80 percent under a contract. - correct answer
✔✔Co-insurance
Sometimes a Medicare patient is admitted to a hospital as an inpatient but, upon internal
review, the hospital determines the services did not meet inpatient criteria and the admission is
changed to observation. This rule has become informally known as "______________." Must be
issued before patient is discharge and before an inpatient claim has been issued. - correct
answer ✔✔Condition code 44
A payment that must be made by a covered person at the time of service. Services that require
a ___________, and the predetermined amount payable for each service, are specified in the
answered graded A+ passed
Defined as "a self-assessment and external peer assessment process used by healthcare
organizations to accurately assess their level of performance in relation to established standards
and to implement ways to continuously improve."
Examples include: TJC, Healthcare Accreditation Program, DNVGL
helps organize patient safety efforts, improves risk management, provides education, provides
professional advice, authority for Medicare certification and other third party insurers - correct
answer ✔✔Accreditation
gathering and analyzing data from patient satisfaction surveys to initiate education and
remedial action and then evaluate actions taken. - correct answer ✔✔Quality Improvement
Initiatives
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 generally short-term rather than long-term or chronic care. -
correct answer ✔✔Acute care
A level of healthcare delivered to patients experiencing acute illness or trauma. Is generally
short-term (<30 days). - correct answer ✔✔Acute Inpatient Care
Written notice issued to a fee-for-service (Original Medicare) beneficiary before furnishing items
or services that are usually covered by Medicare but are not expected to be paid in a specific
instance for certain reasons, such as lack of medical necessity. If not given, patient cannot be
billed for service. - correct answer ✔✔Advance Beneficiary Notice (ABN)
,Also known as a medical directive, healthcare directive or a living will, a legal document in
which a person has outlined what they would like to be done if they are no longer able to make
decisions for themselves due to incapacity or illness. - correct answer ✔✔Advance Directive
Patient receives surgical treatment and is discharged from the facility within four to six hours of
procedure. _______ can occur in an outpatient hospital department or in a freestanding
ambulatory care facility. - correct answer ✔✔Ambulatory Services/Same-Day Surgery
Physician refers patients for scheduled and non-scheduled services such as radiology,
laboratory, and/or other services that are performed in a hospital or clinic setting. Patients leave
the facility once the services are completed. - correct answer ✔✔Ancillary Services
Anti-fraud federal criminal statute that prohibits offering or exchange of anything of value in
exchange for healthcare business referrals, including cash, rent, expensive hotel stays, etc. -
correct answer ✔✔Anti-Kickback Statute
Certain services need _____ while other procedures might not. Some insurance companies
require a CPT code, so make sure you have that available. - correct answer ✔✔Authorization
Requirement
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 ______ are not available for users to view until after the _____ is
run. - correct answer ✔✔Batch Processing
A decision to separately purchase a service, which is typically a part of an indemnity of an HMO
plan. For example, an HMO may "_________" the behavioral health benefits and select a
specialized vendor to supply these services on a stand-alone basis. ____________ may also
include medical devices that the plan pays for in addition to the contracted per diem or case
, rate. Pre-certification/pre-authorization is often required for these benefits and services. -
correct answer ✔✔Carve Out
Coordination of services to help meet a patient's healthcare needs. - correct answer ✔✔Case
Management
Federal agency under the Department of Health and Humans Services (HHS) that administers
Medicare and partners with state governments for administration of Medicaid and other
programs, including the Children's Health Insurance Program (CHIP). - correct answer
✔✔Centers for Medicare and Medicaid Services (CMS)
The _______ is an insurance program for the families of veterans who are not eligible for
Tricare. - correct answer ✔✔Civilian Health and Medical Program for the Veterans
Administration (CHAMPVA)
Free or discounted medical care provided to patients who do not have the ability to pay for all
or a part of medical costs due to limited income or financial hardship. - correct answer
✔✔Charity care
The percentage amount that is payable, per policy provisions, toward medical costs after the
deductible has been met. For example, a patient's _________ amount may be 20 percent, and
the insurance company's _________ could be 80 percent under a contract. - correct answer
✔✔Co-insurance
Sometimes a Medicare patient is admitted to a hospital as an inpatient but, upon internal
review, the hospital determines the services did not meet inpatient criteria and the admission is
changed to observation. This rule has become informally known as "______________." Must be
issued before patient is discharge and before an inpatient claim has been issued. - correct
answer ✔✔Condition code 44
A payment that must be made by a covered person at the time of service. Services that require
a ___________, and the predetermined amount payable for each service, are specified in the
