CHAE flashcards
CHAE · Build recall with a focused review session.
32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Internal audit definition
- An independent, objective assurance and consulting activity designed to add value and improve an organization's operations by bringing a systematic approach to evaluating risk management, control, and governance.
- CAE functional reporting
- The chief audit executive reports functionally to the audit committee or board for charter approval, audit plan approval, budget, and appointment or removal, preserving independence from management.
- External quality assessment
- An independent review of the internal audit activity conducted at least every five years by a qualified external reviewer to evaluate conformance with professional standards and recommend improvements.
- Sufficient audit evidence
- Evidence that is adequate, reliable, relevant, and useful to support audit conclusions; sufficiency depends on risk, materiality, and the quality of the evidence obtained.
- Three Lines Model
- A governance model in which management owns risk, risk and compliance functions provide oversight, and internal audit provides independent assurance to the governing body.
- Residual risk
- The risk remaining after management implements controls and risk responses; it is compared with the board-approved risk appetite to determine whether further action is needed.
- COSO ERM components
- Governance and culture; strategy and objective-setting; performance; review and revision; and information, communication, and reporting. These five components structure enterprise risk management.
- Risk appetite
- The amount and type of risk an organization is willing to accept in pursuit of its objectives, approved by the board and used to guide risk responses and tolerance levels.
- False Claims Act
- A federal statute imposing treble damages and per-claim civil penalties on persons who knowingly submit false claims to government programs; qui tam relators may share 15% to 30% of recoveries.
- Anti-Kickback Statute
- A criminal, intent-based statute prohibiting remuneration intended to induce referrals for items or services reimbursed by federal health care programs, subject to regulatory safe harbors.
- Stark Law
- A civil, strict-liability statute prohibiting physician self-referral for designated health services payable by Medicare or Medicaid unless the arrangement fits a regulatory exception.
- 60-day overpayment rule
- A requirement to report and return identified Medicare or Medicaid overpayments within 60 days of identification; retaining an identified overpayment can create False Claims Act liability.
- Net AR days
- Net accounts receivable divided by average daily net revenue. It estimates how many days of net revenue are outstanding in receivables and is compared with payer terms.
- Clean claim rate
- The percentage of claims accepted on first submission without rejection or denial, calculated as first-pass accepted claims divided by total claims submitted, multiplied by 100.
- Charge lag
- The number of days between the date of service and the date charges are posted in the billing system; high charge lag delays claim submission and increases write-off risk.
- Underpayment variance
- The difference between the contract expected allowed amount and the actual amount paid by the payer, identified by comparing remittance advice with contracted rates.
- Utilization review
- A clinical review process that applies evidence-based criteria to evaluate medical necessity, appropriateness, and level of care for admission, continued stay, and resource use.
- Two-midnight rule
- A CMS payment policy generally treating a hospital stay expected to span two midnights as inpatient, requiring a physician order and documented admission status.
- OPPE
- Ongoing professional practice evaluation: a continuous process for monitoring practitioner competency, quality, and safety using clinical data, peer review, and performance indicators.
- OR turnover time
- The elapsed time between one surgical case leaving the operating room and the next case entering or starting, used to measure operating room efficiency and scheduling performance.
- Donabedian model
- A quality framework evaluating health care through structure, process, and outcome measures; structure includes resources, process includes care delivery, and outcome includes results.
- Sentinel event
- An unexpected occurrence involving death or serious physical or psychological injury, or the risk of such injury, that requires immediate investigation and root cause analysis.
- FMEA
- Failure mode and effects analysis: a prospective, team-based method that identifies how a process can fail, estimates severity and likelihood, and prioritizes preventive actions.
- Hospital-acquired condition
- A condition or complication that was not present on admission and is reasonably preventable through evidence-based care; CMS may reduce payment for selected hospital-acquired conditions.
- HIPAA Security Rule safeguards
- Administrative, physical, and technical safeguards required to protect the confidentiality, integrity, and availability of electronic protected health information created, received, maintained, or transmitted.
- Audit trail
- A chronological record of system activity that identifies the user, date, time, and action taken; it supports security monitoring, investigation, and accountability for electronic protected health information access.
- Business associate agreement
- A written contract required by HIPAA that establishes permitted uses and disclosures of protected health information and requires appropriate safeguards by a business associate.
- Information blocking
- A practice that unreasonably interferes with access, exchange, or use of electronic health information, prohibited under the 21st Century Cures Act except for defined exceptions.
- HIPAA Safe Harbor
- A de-identification method removing 18 specified identifiers, including names, dates, geographic subdivisions, and unique numbers, so that the remaining information is not individually identifiable.
- Minimum necessary
- A HIPAA Privacy Rule standard requiring covered entities and business associates to limit protected health information use, disclosure, and request to the least amount needed for the purpose.
- Benford's Law
- A data analytics rule predicting the expected frequency of first digits in naturally occurring data sets; deviations can signal fabricated amounts, duplicate payments, or outliers.
- Attribute sampling
- A statistical audit sampling method that estimates the rate of deviations from a control or compliance requirement, used to conclude whether a population deviation rate is acceptable.