CHAA Pre-Encounter Questions

Who is the policyholder for Blue Cross, Commercial, and PPO insurances?

___________ the total payments towards eligible expenses that a covered person funds for him/herself and/or dependents. These expenses may include deductibles, co-pays, and co-insurance as defined by the contract. once this limited is reached, benefits will increased to 100% for health services received during the rest of the calendar or policy year.

Who is the policyholder for Medicare and Medicaid programs?

What type of consent is being described: Consent given in writing or verbally by the patient or legal representative. All verbal consents should be following by a written consent as soon as possible.

What may result if a patient is not notified of a clinical pre-requisite (ie - fasting) for their medical exam or procedure?

The number of days that Medicare covers care in hospitals and skilled nursing facilities is measured in _________. It begins on the first day of services as a patient in a hospital or skilled nursing facility and ends 60 days after discharge from the hospital or skilled facility provided that 60 days has not been interrupted by skilled care in any other facility. This is no limit to the number of ____. The beneficiary must pay the inpatient hospital deductible for each _____.

Medicare is a federal health insurance program for:

Who is the policyholder for most HMO insurance plans?

A hospital does not have to be accredited by the Joint Commission to participate in Medicare and Medicaid programs.

____________ is designed to monitor and improve utilization and quality of care for Medicare beneficiaries. The program consists of a national network of 53 ____s responsible for each U.S. state, territory, and the District of Columbia.

Reasonable Safeguards may include:
I. Speaking quietly when discussing a patient's condition with family members in the waiting room or other public areas
II. Isolating of locking file cabinets or record rooms
III. Avoiding using patient names in public hallways and elevators and posting signs to remind employees to protect patient confidentiality
IV. Providing additional security on computers that maintain personal info

Medicare pays by ______ for professional services and most outpatient services performed at a hospital.

How can you provide more information to patients and their families in less time?

_______ are contracts between employers, doctors, and hospitals. The doctors and hospitals or "participating providers" agree to provide their services at a discount. In return, the doctors and hospitals have a volume of patients who are ____ members. Members are not required to select a primary care physician, but they use a participating provider to obtain full coverage. If a member chooses to go to a non-participating provider/facility, their coverage decreases and they pay more out of their own pocket.

Which age group do these communication tips apply to:
- Observe body language as a cue for feelings
- Allow & respect normal expressions of emotions such as crying or anger
- Provide clear, concise explanations
- Encourage questions

Which law does this apply to: Prior to the patient receiving a medical screening exam we can ask if he or she has insurance and take a copy of the card, but we cannot discuss coverage or payments until the patient has been stabilized. We cannot accept payment prior to treatment even if the patient or family volunteers.

For a Medicare patient, if the Advanced Beneficiary Notice (ABN) was signed before services were rendered and Medicare does not pay, the patient may be billed for the services.

Who is considered an Internal Customer for Patient Access:
I. Financial Counseling Office
II. Patient
III. Physician
IV. Fellow Patient Access Rep

_________ are insurance plans that strive to control health care costs by requiring members to receive services at designated facilities. In addition, all services except those provided in life threatening situations, must be provided or approved by a participating physician. Typically members must select a PCP who is responsible for oversight of all of the patient's health care. It is this physician who must approve any non-emergency services. They contract with specific providers.

If a patient with an HMO plan has a policy number with two-digit suffix 00 or 01, what are they likely considered?

From a customer service standpoint, why is it important to perform "financial pre-determination" for services prior to the visit?

Which of the following are Medicaid qualifications?

If a patient with Medicare and a commercial insurance has an injury as a result of negligence (ie - fall on a wet floor where no sign was posted), how should Registration staff determine liability?

If a patient has Medicare or Medicaid as their primary insurance, and the services are the result of an auto accident, who is the primary payer?

What type of consent is being described: Referred to as consent by silence; the patient does not object to treatment.

When communicating with a patient, how can you check for understanding?
I. Taking pacing & timing cues from patient
II. Giving a large amount of detailed information
III. Asking the patient to repeat their understanding of what you said in their own words
IV. Providing patient liability in writing

What type of consent is being described: Consent by law when a patient presents unconscious to the Emergency Department

What type of Tricare is meant to provide expanded medical coverage for Medicare-eligible beneficiaries?

___________ permits certain incidental uses and disclosures that occur as a by-product of permissible disclosures as long as the health care entity applied reasonable safeguards and implemented the minimum necessary standard.

Regardless of the scheduling application used, in addition to the patient's name, what basic info will most likely be needed on the scheduling grid:
I. Physician Name
II. Service Scheduled
III. Date of Service
IV. Time of Service
V. Duration of Service
VI. Special Directives or Requests

All patients and their families should be provided with education and or training with purpose of:
I. Increasing knowledge of patient's illness and treatment needs
II. Learning skills that promote healthy behaviors, support recovery, and accelerate return to baseline function
III. Preventing the patient from ever needing to receive future medical care
IV. Enabling patients to be involved in decisions about their own care

If a patient has Medicare and Medicaid, Medicare will always be the primary insurance.

____________ is an essential part of Access Services because errors made in registration and admissions are transmitted to all these other systems and can impact patient care as well as the financial health of the organization.

Patient have a fundamental right to considerate care that safeguards their personal dignity and respects their ___________________ values. These values often influence patient's perception of care and illness. Understanding and respecting these values guide the provider in meeting the patient's care needs and preferences.

I. Cultural
II. Psychosocial
III. Economical
IV. Spiritual

___________________ is private insurance that is designed to help pay Medicare cost-sharing amounts such as Medicare's coinsurance and deductibles, and uncovered services. They must follow federal and state laws. In most states, the policy must be one of ten standardized policies to help make comparison easy.

What type of consent is being described: Consent given in wirting when the patient acknowledges that he/she has been informed of the planned treatment as well as the risks involved and the risks of nothaving a procedure.

__________ is the percentage amount that is payable, per policy provisions, toward medical costs after the deductible has been met.

Typically, Joint Commission accreditation is a _____ cycle.

A patient appeals to the Peer Review Organization (PRO) provided in their Important Medicare Message (IMM) because they feel they are being discharged early. While the PRO is reviewing their case, the hospital has the right discharge the patient anyway.

Medicare Part A does not pay for custodial services such as help with daily living activities like bathing, eating, or getting dressed.

According to Press-Ganey, which factor has a MAJOR impact on patient's impression of a hospital?

___________ is a decision to separately purchase a service, which is typically a part of an indemnity of an HMO plan.

Who is the policyholder for Tricare (formerly know as CHAMPUS/CHAMP VA)?

A Medicare patient is inpatient at a hospital, what timeframe would they be responsible for a co-pay under their Medicare A benefit?

What are some patient communication techniques?

I. Open ended questions
II. Reflecting
III. Paraphrasing
IV. Using Examples
V. Summarizing
VI. Allowing silences

Medicare pays fixed amounts to hospitals according to the patient's diagnosis. Medicare pays the _____ rate regardless of the actual hospital charges or length of stay.

Upon a patient's first registration at a facility, they will be issued a unique system identification number, also known as:

Who is the policyholder for Workers Compensation?

Which of the following Radiology exams would require an authorization?

________ are monitored by state insurance commissions. Typically, ____ do not require a specific contract with a provider organization to reimburse for patient services. Patients with _____ are not required to select a primary care physician or go to any specific provider.