CHAA flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Master Patient Index

An enterprise-wide database that assigns and maintains a unique identifier for each patient so records can be linked across departments and duplicate or overlay records prevented.

Pre-registration

Collecting and verifying demographics and insurance information before the scheduled encounter, which shortens on-site registration and reduces front-end data errors.

Medicare Secondary Payer Questionnaire

A questionnaire completed for Medicare beneficiaries that identifies other coverage such as an employer group health plan, liability, or workers' compensation, establishing whether Medicare pays primary or secondary.

Point-of-service collection

Collecting the patient's copay, coinsurance, or unmet deductible at check-in or check-out rather than waiting for claim adjudication and a mailed statement.

Prior authorization

Payer approval obtained before a service is rendered; missing or expired authorization typically produces a denial that is not retroactively correctable.

Real-time eligibility verification

An electronic 270 inquiry and 271 response that confirms active coverage, effective dates, benefit limits, and cost-sharing amounts before or at the time of service.

Financial counseling

Screening uninsured or underinsured patients for Medicaid, marketplace coverage, or hospital charity assistance before service, then documenting the outcome and any payment arrangement.

Days in accounts receivable

Total accounts receivable divided by average daily gross charges, where average daily charges equal annual gross charges divided by 365; it measures collection speed.

Net collection rate

Payments received divided by net expected revenue, calculated as gross charges minus contractual adjustments; it shows how much collectible revenue was actually captured.

Clean claim rate

The percentage of claims accepted on first submission without edits or rejections, calculated as clean claims divided by total claims submitted.

MS-DRG prospective payment

Medicare's inpatient acute payment method that pays a fixed amount per discharge based on the assigned diagnosis-related group rather than actual resources consumed.

Contractual adjustment

The difference between billed charges and the payer's contracted allowed amount; it is written off per the payer contract and is not patient bad debt.

Coordination of benefits

Rules that determine which of a patient's multiple insurance plans pays first; the primary adjudicates first and the secondary may cover remaining cost sharing.

835 remittance advice

The X12 electronic transaction a payer sends to report claim payments, adjustments, and denial reason codes, replacing the paper explanation of benefits.

Treatment, payment, operations

The three HIPAA-defined purposes for which a covered entity may use or disclose protected health information without the patient's written authorization.

Minimum necessary standard

A HIPAA requirement to limit protected health information use and disclosure to the least amount needed for the purpose, with treatment disclosures to providers generally exempt.

Breach notification

The HIPAA rule requiring notice to affected individuals within 60 days of discovering a breach, with additional prompt notice to HHS when 500 or more individuals are affected.

EMTALA

A federal law requiring a medical screening examination and stabilization for anyone presenting to an emergency department, regardless of insurance status or ability to pay.

Advance Beneficiary Notice

The CMS-R-131 form a Medicare beneficiary signs before a service expected to be denied as not medically necessary, accepting financial responsibility for the charge.

Informed consent

A voluntary agreement given after the patient receives the nature of the procedure, its risks, benefits, alternatives, and the right to refuse, from a competent patient or representative.

Advance directive

A legal document stating a patient's wishes for future medical care or naming a surrogate decision-maker; patients are asked at registration whether one exists.

Teach-back method

A technique in which the patient explains instructions back in their own words, confirming understanding and revealing gaps before the conversation ends.

Qualified medical interpreter

A trained interpreter used for clinical, consent, and financial discussions; Title VI language access requirements mean family members should not serve as interpreters.

Service recovery

A structured response to a service failure: acknowledge the problem, apologize, resolve or escalate, thank the patient, then document and follow up.

Health literacy

A patient's ability to obtain, process, and understand health information; plain-language materials at roughly a fifth- to sixth-grade reading level improve comprehension.

De-escalation techniques

A calm tone, use of the patient's name, active listening, offered choices, and safe physical distance used to defuse conflict before it becomes a safety concern.

Two patient identifiers

Verifying identity with two independent data elements such as full name and date of birth; room or bed number is never an acceptable identifier.

ADT feed

Admit-discharge-transfer electronic messages that notify downstream systems of patient status changes, driving census, EHR updates, and billing triggers.

HL7 version 2

The widely used messaging standard for exchanging clinical and administrative data such as ADT messages, orders, and results between healthcare applications.

FHIR

Fast Healthcare Interoperability Resources, a modern standard using RESTful web APIs and standardized resource formats to exchange healthcare data between systems.

X12 837 claim

The electronic transaction format used to submit professional or institutional healthcare claims to payers, usually routed through a clearinghouse.

Downtime procedure

A documented paper-based process for registering patients and capturing charges when the information system is unavailable, with back-entry performed after restoration.