CHAA cheat sheet

Registration accuracy depends on the Master Patient Index: incorrect demographics or identifiers create duplicate or overlay records that threaten patient safety and split the billing history.

Real-time eligibility verification uses the X12 270 inquiry and 271 response to confirm coverage, effective dates, plan type, and cost-sharing before or at the encounter.

Prior authorization must be obtained before the service date; authorizations are generally non-retroactive, so a missed auth becomes a technical denial or a contractual write-off.

Point-of-service collection targets the patient's copay, coinsurance, and unmet deductible at check-in or check-out; copays are typically fixed and coinsurance is a percentage of the allowed amount.

The Medicare Secondary Payer Questionnaire (MSPQ) is completed for every Medicare beneficiary to identify other coverage (employer group health plan, liability, no-fault, workers' compensation) and set payer order.

Referral management requires matching the referral to the correct payer, specialty, and number of authorized visits; an expired or misdirected referral produces a denial.

Financial counseling screens uninsured and underinsured patients for Medicaid, marketplace plans, or hospital financial assistance before service, then documents the outcome and any payment arrangement.

Pre-registration rate and registration error rate are front-end key performance indicators; higher pre-registration reduces on-site registration time and downstream edits.

Scheduling accuracy depends on matching appointment type to the required resource, equipment, and provider time, with no-show and cancellation status codes captured for capacity analysis.

Revenue cycle sequence: scheduling/pre-registration → registration → charge capture → coding → claim submission → remittance posting → denial management → patient collections.

Days in A/R = total accounts receivable ÷ average daily gross charges, where average daily gross charges = annual gross charges ÷ 365.

Net collection rate = payments received ÷ (gross charges − contractual adjustments); the result measures how much of the collectible (net expected) revenue was captured.

Clean claim rate = claims accepted on first pass ÷ total claims submitted; rejection rate is its complement and is driven by front-end data errors.

Denial rate = denied claims ÷ total claims; denials are classified as registration/technical, coding/clinical, or payer/contractual, and each class has a distinct root cause and fix.

Medicare inpatient acute care is paid under MS-DRG prospective payment; hospital outpatient services under OPPS using APCs; physician services under the Medicare Physician Fee Schedule derived from RBRVS.

A contractual adjustment is the difference between billed charges and the payer's contracted allowed amount; it is written off per contract and is distinct from bad debt and from charity care.

Coordination of benefits rules decide payer order among multiple plans: the primary plan adjudicates first and the secondary plan may cover remaining copay, coinsurance, or deductible.

X12 EDI transactions in the cycle include 270/271 eligibility, 278 prior authorization, 276/277 claim status, 837 claim submission, and 835 remittance advice.

HIPAA permits use or disclosure of protected health information without authorization for three purposes only: treatment, payment, and health care operations.

The minimum necessary standard limits uses and disclosures to the least PHI needed for the purpose; disclosures to a provider for treatment are generally exempt from the standard.

The HIPAA Security Rule requires administrative, physical, and technical safeguards for electronic PHI, including unique user IDs, access controls, and audit trails.

Breach notification: affected individuals must be notified without unreasonable delay and no later than 60 days after discovery; breaches involving 500 or more individuals also require prompt HHS notice and media notice.

EMTALA requires a medical screening examination and stabilization for any patient presenting to an emergency department regardless of insurance status or ability to pay; payment inquiry cannot precede the screening exam.

A valid Advance Beneficiary Notice (CMS-R-131) is signed by a Medicare beneficiary before a service that is expected to be denied as not medically necessary, transferring financial responsibility to the patient.

Informed consent requires disclosure of the nature of the procedure, risks, benefits, alternatives, and the right to refuse, given voluntarily by a competent patient or legally authorized representative.

A valid HIPAA authorization must describe the information to be used or disclosed, name the recipient, state an expiration date or event, and inform the patient of the right to revoke.

When state privacy law is stricter than HIPAA, the stricter state requirement applies; compliance requires meeting both where they differ.

The teach-back method asks patients to restate instructions in their own words; it verifies comprehension rather than assuming that information delivered equals information understood.

Title VI language access obligations require a qualified medical interpreter for clinical, consent, and financial discussions; family members, especially minors, should not be used as interpreters.

Patient education materials are written at roughly a fifth- to sixth-grade reading level with plain language to support low health literacy.

Service recovery follows a structured sequence: acknowledge the problem, apologize, resolve or escalate, thank the patient, then document and follow up.

Two patient identifiers must be verified before discussing any protected information by phone or at a counter; identify yourself and your department first.

Confidentiality in public spaces: avoid speaking patient names in waiting areas, lower voice on calls, and move financial or clinical discussions to a private area.

De-escalation uses a calm tone, the patient's name, active listening, offered choices, and safe physical distance; escalate to a supervisor or security if threats persist.

Complaints are documented with date, details, and resolution, then routed to patient relations or risk management within the organization's response timeframe.

The Master Patient Index issues a unique identifier per patient; duplicate and overlay records are a leading cause of wrong-patient errors and must be resolved through a documented merge process.

Two patient identifiers (for example, full name plus date of birth) are required for identification; room number, bed, or service is never an acceptable identifier.

ADT (admit-discharge-transfer) messages notify downstream systems of status changes and drive census, EHR, and billing updates.

HL7 version 2 remains the dominant messaging standard for ADT, orders, and results; FHIR provides RESTful APIs and standardized resources for modern interoperability.

Key X12 transactions: 270/271 eligibility, 278 prior authorization, 276/277 claim status, 837 claim submission, and 835 remittance advice.

Downtime procedures use paper forms and manual logs for registration and charge capture, with back-entry after restoration and periodic testing of the process.

Role-based access with unique user IDs and audit trails satisfies HIPAA technical safeguard expectations and supports investigation of inappropriate record access.

Phishing and compromised email credentials are among the most common causes of healthcare data breaches; suspicious messages are reported rather than opened or forwarded.