CHAA EXAM ENCOUNTERS

Question Answer
Some patients may be unable to sign because they are __________. A.If so, there is usually a guardian or durable ______ of _______ assigned. B. Patient access should obtain a ____ of the power of attorney form to be included in the medical record. Incapacitated, Power of Attorney, Copy
Consent regarding ______ is complicated. Consent must be obtained from a parent or legal guardian prior to providing ___-________ services for a minor. Minors, Non-Emergent
If a minor presents for services without a guardian, patient access staff can contact via ____ for verbal consent, if they document on consent form. Some facilities may require a _______ staff member to verify verbal consent and document as well. Phone, second
Minors presenting for scheduled/elective procedures without a guardian should require __________ and _______ ______ to confirm that the necessary consents have been obtained. Supervisory and Clinical Involvement
Some states DO NOT require consent for minor treatment to obtain services for ______ related services, contraceptive/STD related services, mental health Services, and substance abuse treatment. Pregnancy
____________ _______ do not need consent from a guardian. emancipated Minors
_____________ is not available in every state in U.S. Where available, minors obtain legal adulthood before the normally required age. Rights associated with this might include the ability to ____ legally binding contracts, own property. Emancipation, Sign
In most cases, there are 3 circumstances in which a minor becomes emancipated. 1. enlisting in the _______, getting ________, or obtaing a court order from a _______. Military, Married, Judge
The HIPAA _______ of ______ _______ (NOPP) explains how protected health information (PHI) is used and disclosed in healthcare. Notice of Privacy Practice
A. All providers are required to make the NOPP available to _______ and obtain a _____ acknowledgement from patient that the information was offered. Patients, Signature
The signed NPP remains in effect for all subsequent (later) visits unless the Notice ______. A. When there is a _______ revision of the Notice, providers must distribute the new Notice to the patients and obtain a new _______. Changes, Materials, Signature
Patients have the right to file a complaint or grievance (when) ________ during the healthcare encounter. anytime
Patient's rights and responsibilities must be _____ throughout the facility and many states require a _______ version to be available upon admission. Posted, Written
The PATIENT SELF DETERMINATION ACT (PSDA) of 1990 affords patients the right to ______ or ______ treatment. Receive or refuse
A. State laws vary on which legal documents to recognize regarding Advanced Directives, Living Wills, and Power of Attorney for healthcare, but no state may ________ (prevent) the patients right to participate in ______ _______. Prohibit, Decision Making
An _______ _______ or ________ _______ is written instructions regarding an adult patients wishes when they cannot make healthcare decisions for themselves. Advance Directive or Living Will
A Durable ______ of ______ is the portion of the Advance directive where an adult person appoints a _____ or ______(actual person) to make decisions if the patient becomes incapacitated and unable to make their own decisions. Power of Attorney, Proxy or Advocate
The PSDA requires that patients be ________ about advance directives and _______ if they have completed one. A. if so, the provider is responsible to ____ it in patients medical file in an easily ______ place to all healthcare providers. Educated, ask, place, viewable
An Advance Directive is activated when a patient becomes _________. A person can _____ (cancel) it at any time by destroying all copies. Incapacitated, Revoke
'AN IMPORTANT MESSAGE FROM MEDICARE' is a form explaining beneficiary rights and instructions on how to file an ______ (formal complaint) in the event that the patient disagrees with the discharge plan or has a complaint. appeal
A. The form should be _____ to the patient _____ to admission and signed by the patient stating they have received the information. Explained, Prior
B. The provider must re-present the form to the patient _____ to discharge giving the patient the opportunity to initiate the appeal before the discharge occurs. Prior
FIRST PARTY – _______SECOND PARTY – ________THIRD PARTY – ________ Patient, Provider, Payer
Patient Insurance and Payment information must be correctly obtained from the patient to insurer proper claim submission to the ______ ______ _______. Third Party Payer
MEDICARE is the nation's largest health insurance program covering more than ___ million Americans annually. 40
MEDICARE BENEFICIARIES are those who are at least ___ years old, under the required age, but qualify due to _____ and those with _______. 65, Disability, ESRD
TRADITIONAL MEDICARE (PART A/B) usually only covers prescription drugs for _______ stays. A. It dies not cover prescription drugs for _____ services. B. Everyone with Medicare can obtain Medicare Part _ which is prescription drug coverage. Inpatient, Outpatient, Part D
Generally patients are eligible for Medicare if the patient or their _____ worked for at least ___ years in Medicare covered employment. A. is __ years or olderB. and is a ___ or permanent resident of the U.S. Spouse, 10 years, 65, Citizen
Medicare Beneficiaries do not pay a premium IF THEY RECEIVE BENEFITS FROM:A. _____ _____ B.the _____ Retirement BoardC.if they are eligible for previous requirements but haven't _____ for them yet. D. if their spouse had Medicare covered ____employment Social Security, Railroad, Filed, Government
They will also not pay a premium for Part A if they are ____ age 65 and have received Social Security or Railroad Retirement Board disability benefits or __ months or has ___ and meets certain requirements. Over24 ESRD
The ______ ______ _______ _________ determines who pays first for Medicare patients. Medicare Secondary Payer Questionnaire
The private insurance industry uses the term ____________ __ ____________ to determine the primary and secondary payers. Coordination Of Benefits
The MEDICARE SECONDARY PAYER QUESTIONNAIRE asks for information to determine if the injury is ____ relatedA. if the patient has _____ insuranceB. is ___ years or olderC. if they have coverage through a ______ _______ ______ ______ (LGHP) WorkA. Group B. 65 C. Large Group Health Plan (LGHP)
D. if the patient is covered under their ______ insuranceE. if they qualify due to _________ or _____F. if they qualify under the Federal _____ Lung Program, G. _________ Administration H. Government ________ Grant. D. Spouses E. Disability or ESRDF. Black G. Research
If the patient is 65 years or older and is covered by a group health plan with 20 OR MORE employees due to their own or their spouse's employment, _____ pays first and _______ pays second. Large Group Health Plan (LGHP), Medicare
If the patient is 65 years or older and is covered by a group health plan with LESS THAN 20 employees due to their own or spouse's employment, ________ pays first and _______ pays second. MEDICARESmall Group Health Plan (SGHP)
If the patient is disabled and covered by a large group health plan from work or from a family member's employer who has 100 or more employees, _____ pays first, and _______ pays second. Large Group Health Plan (LGHP), Medicare
If the patient is disabled and covered by a Large group health plan from work or from a family member's employer who has less than 100 employees, ________ pays first, and _____ pays second. Medicare, Small Group Health Plan (SGHP)
Medicare Part A entitled beneficiaries who have terminal illnesses and a life expectancy of less than 6 months can elect _______ benefits in lieu (instead) of standard Medicare coverage as long as the provider is a ______ certified hospice provider. Hospice, Board
MEDICARE ADVANTAGE PLANS are health plan options like ___ or ____ run by _______ companies who are approved by Medicare. PPO or HMO, Private
Other names for MEDICARE ADVANTAGE PLANS are ______ and ___ plans. Part C and MA
MEDICARE ADVANTAGE PLANS are NOT ___________ _________. MA plans replace coverage and are not additional. (Supplemental=additional) Supplemental Insurance
There are ___ (number) different kinds of Medicare Advantage Plans. Most of them, like HMOs, have a _______ of doctors and hospitals the patient must choose from to be covered. 5 , Network
A. Others who allow the patient to go to any doctor who agrees to accept plans terms of payment are known as _______ ____ ___ _______ Plans. Private Fee For Service
Another MA Plan that serves certain Medicare beneficiaries who are chronically ill, live in institutions like nursing homes, or who have other special needs are known as _________ ________ _______ Plans. MEDICARE SPECIAL NEEDS
Medicaid is a _____ administered program where each sate sets its own guidelines regarding eligibility and services. State
Many groups of people are covered by Medicaid but within these groups certain requirements must be made. These requirements may include _____. Age
A. medical condition (_________,________,______, or aged)B. income and resources (____ ________, ____ ______, etc.) . whether patient is a ___ ___________ or a lawfully admitted _____________. A. Pregnant, Disabled, BlindB. Bank Accounts, Real EstateC. US Citizen, Immigrant
D. The rules for counting income and resources vary from state to ______ and group to _____. State , Group
Medicaid does not provide medical assistance for all ____ _________ residents. LOW INCOME
A. Even the most unfortunate persons must meet certain ___________ requirements. B. ___ ____ is only one test for Medicaid eligibility; C. ______ and _______ are also tested against eligibility thresholds. A. EligibilityB. Low IncomeC. Assets and Resources
_______ and _____ are examples of assets. (Jewelry, Land) Houses and Cars
Medicaid coverage may start retroactive to any or all of the ______ months prior to application. When coverage stops, it usually stops at the ____ of the moth in which a person's circumstances change. 3 , END
MANAGED CARE is any system that aims at delivering healthcare and controlling _____. A. They TYPICALLY use a ______ _____ ______ who acts as a gatekeeper through which a patient has to go through to obtain special health services. COSTS, Primary Care Physician
Which Managed Care Plan uses a PCP? HMO
Which uses a network of doctors? PPO
MANAGED CARE ORGANIZATIONS frequently contract with health care providers like ___ and ___ who agree to deliver services according to specific stipulations. HMO and PPO
These stipulations usually revolve around the _______ and medical _________ of the services. Payment, Necessity
Some Physician Orders may be taken ______ (written by a nurse/secretary/etc), but the order must be ____________ (checked for accuracy) within a certain period of ______. Verbally, Authenticate, Time
A small number of procedures are known as ____-referred procedures and do not require a Physician's Order. One example is a __________ _________. Self, screening mammogram
MEDICARE MEDICAL NECESSITY refers to CMS guidelines stating that Medicare will only pat for services that are ____________ and ___________. A. For outpatient services, _________ of medical necessity is required in order to pay for services. Reasonable , Necessary, Evidence
Medicare has established that ____________ are only justified for specific diagnosis as established by the _____ _________ ________ _______ (LMRP). Procedures, Local Medical Review Policy
Many facilities install ________ for the sole purpose of checking medical necessity while others check by a manual (by hand) process. Software
If the Physician's diagnosis code for a procedure is not supported by the LMRP, then one of two things must happen:A). the physician must be contacted to provide additional supporting _________ or B). the patient is notified via _______ _________ _______. Documents, Advance Beneficiary Notice
The ADVANCE BENEFICIARY NOTICE is given to beneficiaries informing them that Medicare is ____ _________ to provide coverage in a specific case. Not Likely
A). The ABN must be __________ reviewed (!!!!!!!!) with the beneficiary or his/her rep before it is _______ and it must be delivered far enough in advance of the test or procedure that they have enough time to consider other _______. Verbally, Signed, Options
ABNs are never signed in ______ or ________ situations, and once the form is signed: A). a ____ is given to the patient B). white the _______ is retained by the facility. Urgent or Emergent, Copy, Original
Charges associated with tests and procedures that are not medically justified are not reimbursable without signed ____. A). These charges cannot be written off to ____ ____ or _______. ABN, Bad Debt or Charity
The accepted diagnostic coding system in the United States today is the ________ (abbreviation). A). It was developed ___ years ago and includes an _________ list of diseases, injuries, and procedures. ICD-9-CM, 30, Outdated
B). Therefore, an updated system, the _______was developed which increased the number of codes from 13,600 to 120,000 and is more specific and accurate of current and future diagnoses and procedures. However, the new version has yet to be implemented. ICD-9-CM
The HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) is divided into two levels. ________ is Current Procedure Terminology used to classify services of physicians, hospitals, and ambulatory service center. Level 1
___________ is HCPCS codes used to classify non-physician services. Level II
WAYFINDING includes ____________ and alternate means of __________ to the facility, A). location of _________ and patient ____ -______ points in relation to location of services. B). campus _____ and visual _____ (clues, reminders) such as color-coding. Directions, TransportationA). Parking, Drop-OffB). Maps, Cues
WAYFINDING IS: A). An individual ____ _________ because some people will have more knowledge of the facility that others. B). A _____ of generating a _______ solution providing _____ to assist the ____________ process. A). User ExperienceB). Process, Design, Aids, Navigational
C). Tools often include _____/user guides/_______ __________ (asking directions)/written directions, ________ elements (things you can touch), consistent _______ and environmental graphics. C). Maps, Audible Communication, Tactile, Terminology
D).A ? that recognizes the human factor and brings communication to the lowest ? denominator including provisions for users ? with their environment who are under ? and may have special needs such as being ? impaired. Plan, Common, Unfamiliar, Stress, Visually
E. A ________ that includes careful ___________ preplanning and commitment. System, Orchestration
Wayfinding tools should be compliant with the ____ and _____ (use abbreviations but know their meanings). ADA and JCHAO
PATIENT TRACKING refers to documenting the _______ and ________ times of patient and also allows them to know a patient's location at ___________ during the encounter. Arrival, Departure, Any Point
A). It also includes knowledge about _____ availability, if a patient has recently been ______, and monitoring a patient's total ______ in care. Room, Treated, Time
PATIENT TRACKING is important because patient ________ is compromised when there is a _____ occupancy and ____________. Safety, High, Overcrowding
A). In order to protect patients, the _____ _______ (JCAHO) made management of patient tracking and patient _____ requirements. Joint Commission, Data
B). According to their standards, hospitals must look at and use ____ to make changes and they must have a patient ______ ________. Data, Flow Committee
Patients flow is delayed when a ____________ or ________ cannot be located. This causes increases patient and staff wait times and results in a _________ for other departments and clinical staff. Wheelchair, Stretcher, Bottleneck
A new technology that transmits the identity of any object or person wirelessly using radio waves is a ______ __________ ___________ Device (RFID) is often used to assist in patient tracking. Radio Frequency Identification
CENSUS MANAGEMENT of hospital beds has become a high pressure requirement because hospitals are needing to do _____ with ____ resources. More, Less
Electronic bed management systems may _______ (communicate) with other clinical or housekeeping systems to facilitate communication. Interface
CUSTOMER INFORMATION must b kept confidential. Doing so is the one of the most _________ duties of any healthcare organization. However there are times when ______ information may be relayed to others. Important, Limited
OPTING OUT OF THE FACILITY DIRECTORY is a pt right and Pt. Access Staff are ______ to ask pts if they wish for their ____ and ______ within the hospital not to be made available to the public. A). They must ___ pts. on the implications of their choice. Required, Name, Location, Educate
When a patient 'Opts Out', a confidentiality flag is placed in the computer system alerting staff that ___ ___________ may be given to callers, visitors, florists, or clergy. No Information
MEDICAL RECORDS are maintained to: A). Provide a means of communication between the _______ and other members of the ________ team providing care for the patient. Physician, Healthcare
B). Provide a basis for evaluating the ________ (amount) and ____________ (necessity) of care C). Provide data to substantiate (proof) __________ claims Adequacy, Appropriateness, Insurance
D). Protect the _______ interest of the patient, the facility, and the physician E). Provide _______ data for research and education Legal, Clinical
The provider _____ the health records but the patient has the right to ________ obtain a _____ of, and ________ (prevent) release of a medical record. Owns, Inspect, Copy, Restrict
A). Protection of PHI is a primary aim of HIPAA. There should be evidence that the requestor has a ______ right to use/view the information on a _______________ basis. Legitimate, Need to Know
B). The patient has the right to know who has _________ the PHI, AND EXCEPT FOR LIMITED CIRCUMSTANCES, THE PATIENT SHOULD PROVIDE __________ CONSENT FOR THE RELEASE OF ANY PHI. Accessed, Written
COLLECTING PATIENT LIABILITY is becoming more important due to the rising cost of _________ and insurers shifting a greater share of their healthcare costs to ____________. Healthcare, Consumers
A). Receiving revenue directly from __________ is becoming increasingly important to a hospital's bottom line. patients
BEST PRACTICES FOR COLLECTING PATIENT LIABILITY are those that: A). Take place during _______ or _____________. B). Assess (evaluate) the patients __________ coverage and _________ resources. Scheduling, Registration, Insurance Financial
C). _____ all patients to determine ability to pay vs. need for assistance. D). _______ payment from those able to pay at Point of Service (POS) and arrange for payment terms for balance based on hospital's collection policies. Screen, Collect
E). _____ payment sources for those who cannot afford care. Find
The percentage of employers offering health coverage fell __% between 2000 and 2005. 9
A). As a result, _______ has become the fastest growing hospital revenue segment. B). With the growing prevalence of high-deductible, consumer-directed health plans, self-pay could easily exceed ___% of hospital revenues by 2012. Self-Pay, 30
With the growth in self-pay and uninsured populations has come an increase in ____ _____. Bad Debt
A). Most hospitals collect between 2% and 8% of charges to uninsured patients (That's $__ – $__ of every $100). B). With overall hospital profit margins being only 3% to 5%, hospital can't afford to _____ self pay accounts. $2 – $8, Ignore
The Tax Exempt Hospital Responsibility Act ensures that hospitals with beneficial tax exemptions invest at least ___% of total operating costs in providing care for poor patients. 8
HEALTHCARE SPENDING ACCOUNTS with high deductibles ($5000-$10,000) require hospitals to seek more __________ directly from patients that would previously have been collected from insurance companies. Reimbursement
The _________ ______ is a series of predictable steps that begin the first day a patient has contact with the provider and ends when the patient's bill is settled. Revenue Cycle
Many healthcare providers make the MISTAKE of ASSUMING that the collection process begins with collection _______ __. Follow Up
The FOUR MAJOR CONTROL POINTS for collection begin before _____ __ begins. Follow Up
The __________ and __________________ that occur during these FOUR MAJOR CONTROL POINTS WILL AFFECT whether or not a patient's bill will be __________. Activities, Communication, Collected
The FIFTH MAJOR CONTROL POINT is collection ________ __. Follow Up
There is a PHYSCHOLOGICAL advantage of collecting during the _______ stages of the revenue cycle. Early
A). When collection occurs during the first four control points, the interaction is with a _______ not a ________. B). Studies show that PATIENTS are more likely to pay their liability (bills/balance) than a ______. A). Patient, DebtorB). Debtor
__________ is the portion of the covered expenses that the insured must pay per benefit period before insurance pays for the benefits. Deductible
A). Deductibles are standard in many indemnity and PPO policies and usually based on the ________ year. B). Since the deductible must be paid before the insurance pays any benefits, that amount must be removed from the calculation at the __________. Calendar, Beginning
____________ ____ ___ ________ is the most money an insured can be expected to pay for covered expenses per benefit period. Maximun Out Of Pocket
A). The maximum limit ______ from plan to plan. B). some insurance companies count deductibles, co-insurance, or co-payments towards the limit, others ____ _____. Varies, Do Not
C). Once the maximum has been met, many health plans pay ____% of certain covered expenses. 100
At the point of registration, accurate information regarding the patients out of pocket obligations must be ________ and __________ to the patient. Calculated, Communicated
In addition to calculating the estimated amount due for the current or upcoming visit, patient access employees should also review _______ balances to determine if patient has any liability. Previous
If the patient owes on a previous bill, the patient access specialist should _______ payment for balance during current collection. Request
Many facilities provide a _______ _______ ______ to the patient/guarantor to communicate the amount due. Patient Liability Letter
If a patient owes only co-payment amount as indicated on their card, it isn't necessary to use a ____ to determine the amount due. Tool
MEDICARE LIABILITY PAYMENTS PART A is due at the start of each new _____ _ ______. A). A new 'spell' is determined as being out of an acute care or Long Term Acute Care Hospital for more than __ consecutive/uninterrupted days. Spell Of Illness, 60
B). A _____ co-insurance amount is due from the patient for days ____-____ of an inpatient spell of illness. C). A daily co-insurance amount is also due for the patient to use their ________ ________ (LTR) days ___-___. Daily, 61-90, Reserves, 91-120
The patient must sign a waiver for use _____ days. LTR
MEDICARE PART B DEDUCTIBLE is due at the beginning of each _________ year, and is usually met with a single doctor's office visit. A). The patient must also pay a ___% co-pay for most outpatient procedures. Calendar, 20
A common problem for hospitals is the high percentage of claims that payers reject due to inaccurate ____ entered during __________. A). For many hospitals, these inaccuracies remain the number ____ cause for claims being rejected or denied. Data, Registration, one
Incorrect ________ ____ _______ (CDEs) result in returned mail and make it difficult to perform routine collection activities with the patient. Critical Data Elements
Some CDEs commonly entered in error include: A). Patient name on claim not matching patient name on file with _____. B). Incorrect or missing _________ ___. C). Claim submitted to ______ _______. Payer, Member ID, Wrong Payer
D). Incorrect ________E). Missing or incorrect _______ ______F). Missing ______________/_______________/______________ information needed to submit claim. Address, Phone Number, Pre-Certification/Authorization/Referral
Confirming this information has been collected an is correct at time of registration eliminates many ________ issues associated with billing payers and collecting money from patients. Downstream
DATA INTEGRITY refers to the process of ensuring that data is _______ and ________. A). In order to verify information, patient access must develop a consistent _____ to measure the ______ and verify the ______ of the data collected. Consistent and AccurateA). Policy, Quality, Accuracy
The PRIMARY ROLE of patient access is to create the basis of the _____ _____ through the capture of specific information prior to the Encounter. Medical Record
Patient Access Staff gather data classified in to broad (widespread) categories: __________ data and ___________ data. Administrative, Clinical
______________ data is divided into three sub categories: Demographic, Socioeconomic (Cultural/Income), and Financial data. Administrative
Such data has a direct relationship to patient care and to the ________ integrity of the healthcare facility. Financial
The most common elements of PATIENT IDENTIFICATION are ______ _____and _____ of ______. Legal Name, Date of Birth
Due to a heightened awareness of protecting patient's identity, some facilities no longer require ________ __________ _______ as a patient identifier. Social Security Number
The data collected provides valuable statistical, ________ and _________ information. Clinical and Financial
PROPER _________ ___________ ________ will have processes in place to verify that the administrative data captured during the registration process are consistent and accurate. Quality Measurement Programs
The main repository (database/warehouse) for PATIENT ACCESS is the ___________ _________ and __________ system. Admission, Discharge, and Transfer
The most important patient tracking link and resource in a healthcare facility is the __________ _________ _______. It is used to minimize duplicate records by matching patients being registered for care to their previous medical records. Master Patient Index
Failure to link patients to the correct existing medical record number may compromise patient _______ and negatively impact the ability of the organization to obtain _________ for services. Safety, Payment
Through searching the scheduling information and/or the physician order, patient access must capture the _______ for the encounter and if appropriate, the ___________ information. Reason, Procedure
List six components of physician orders: A). ______ B). _________ nameC). _______ D). _____ or ________ ordered E). diagnosi, signs, or symptoms; and ___________ signature. A). Legible B). Patient C). Date D). Test or Therapy E). Physician
DATA ACCURACY can be measured by a _______ system (by hand), but in recent years _________/automated Quality Assurance processes have been designed to provide real time feedback. UMHC's system is known as _________. Manual, Electronic, ACCUREG
Some benefits of AUTOMATED QUALITY ASSURANCE PROGRAMS are: ____% of registration audited A). Registrars receive feedback on errors and _____ _______ B). Errors are corrected earlier in the ______ cycle C). Clean data before ____ _____; etc. 100, Self Correct, Revenue, Bill Drops
Internal auditing provides a snap-shot of the results produced by current ______. A). Accuracy of the registration data results in fewer _______ rejected ______, and other delays. ProcessA). Denials, Claims
B). The data measured is used to implement ______________ ____________ designed to meet the revenue cycle goals of reducing Accounts Receivable (A/R) and improving cash flow for the organization. Performance Improvement
RESOURCE MANAGEMENT isthe efficient and effective _________ and __________ of an organization's resource when they are needed. Resources include financial supplies, human resources, and information technology (IT). Utilization and Deployment
One of four most valuable resources is _____. A). The largest expense item in the patient access budget is _______. B). This expense can be managed by hiring ______ staffing levels and using ____- staffing to cover inconsistent volumes. Time A). Salary B). Core, Flex
CUSTOMER SERVICE impressions are the result of staff ________ and _______. Behavior and Attitude
According to the Press-Ganey survey, "satisfied patients become _____ patients," who will ___________ their friends and family yo our facility. Loyal, Recommend
Patient Access Staff must provide _____ and __________ registration services. Timely and Accurate
A). Demonstrate a high level of understanding concerning ______ _____ payer requirements. B). ____ of ____ expenses. C). _________ ______ programs, and government regulations and guidelines. A). Third PartyB). Out of PocketC). Financial Assistant
Compassion is as significant as _____________ in creating a positive healthcare experience. A). Simple gestures such as ________ and making ____ _________ show genuine care and concern. Competence, Smiling, Eye Contact
Avoid referring to patients using slang terms such as _______ or _______. A). Instead, ask the patient their ________ ways to be addressed. Honey or SugarA). Preferred
EVALUATING CUSTOMER SATISFACTION results from obtaining ______ and ________ feedback. Active, Passive
A). _____ feedback occurs when the provider requests information from the patient. B). ________ feedback is the formal process of obtaining and responding to patient compliments and concerns. A). ActiveB). Passive
Customer surveys, comment cards, and call back programs are examples of ________ feedback. Active
Letters from patients and families and conversations with patients and families are examples of ________ feedback. Passive
Both positive and negative feedback have a purpose in health care surveys. A). ______ feedback provides an opportunity to practice positive employee engagement. B). _____ feedback is an opportunity to apply quality improvement. A). PositiveB). Negative
SURVEY RESULTS ate the best way to find out if a customer is _______. A). Surveys can be written or _______ B). The survey should be conducted _____ after the encounter while the experience is fresh in the patient's mind. SatisfiedA). VerbalB). Soon
SURVEY RESULTS are used to measure _______________ and engage in quality ___________________ initiatives. Satisfaction, Improvement
SURVEY RESULTS also have an effect on patient selection of the hospital and financial reimbursement for services rendered. For example, many consumers are turning to published surveys to see which providers ____ or _____ expectations. Meet, Exceed
Insurance companies are also moving towards only reimbursement services and treatments from providers who meet or exceed a level of ______________ ______________. Performance Benchmark
Customer Service Survey information is used forpublic relations (___________ scores) and performance improvement (___________ scores). Positive, Negative
When initiating a customer satisfaction survey, you must determine: A). What data measurements are ________ B). What data measures are important to the organization ______ ______ process. C). What data measures are important in day to day _____________. A). Required B). Decision Making C). Management
The sample survey questions relating to service by individual care givers show compassion, concern, and empathy more than ________ competence. Clinical
Healthcare Facilities also use ________ surveys to gain feedback concerning employee engagement and loyalty to initiate programs to impact employee _________ and customer service scores. Internal, Retention
The purpose of any QUALITY IMPROVEMENT program is to: A). _______ and ________ data B). Initiate __________ or _________ action C). and to ___________ actions. A). Collect, AnalyzeB). Education, RemedialC). Evaluate
TJC defines quality control as the performance processes through which actual performance is ________ and compared with _______ and the difference is ________ on. Measured, Goals, Acted
TJC defines QUALITY ASSURANCE as the continuous study and improvement in providing healthcare to meet the needs of _____________. Individuals
TJC defines PERFORMANCE IMPROVEMENT as: the continuous study and _______ of a healthcare organization _________ and _________ to increase the probability of achieving desired outcomes. Adaption, Functions, Process
KEY PERFORMANCE INDICATORS help an organization define and measure progress toward organizational ______. Goals
A). KPI's must be quantifiable (______________) measurements.B). Agreed to ________________.C). And reflect the critical _______ factors of an organization. A). MeasurableB). BeforehandC). Success
There are a number of KPIs involved in the healthcare ________ ______. A). In the past, hospitals tended to focus their efforts at the _____ of the cycle (on billing and collection). Revenue CycleA). End
B). But most revenue cycle problems originate early on when the hospital is ________and _________patient information needed to ensure a clean claim. Collecting, Verifying
C). Therefore, hospitals have shifted their focus on _______ _______ processes to help ensure problems do not arise in the first place. Paient Access
Lack of alignment between _________ and __________ functions is a leading cause of revenue-cycle problems for many hospitals. Clinical, Financial
Proper alignment and focus on: A). __________ __________B). __________ , and C). __________ ______________ _________ functions will positively affect revenue-cycle results a monitored by KPIs. A). Patient Access B). ClinicalC). Patient Financial Service
The following Key Performance Indicators generally monitored in patient access are: A). Pre-registration _________ B). Scheduling and arrival _____ ____ C). ______ rate D). ______/POS ________ E). ______ dollars F). ______/________ Satisfaction A). Percentage B). Wait Times C). Accuracy D). Upfront / Collections E). Unbilled F). Patient/Employee
The following KPIs are generally monitored for various departments int he revenue cycle. A). Days in ______ Receivable /A/R Days B). Total _____ collections C). ___________ ____ _______ _____ (DNFB) D). _______ claims / _____ claim percentage A). Account B). Cash C). Discharged Not Final Bill D). Rejected, Clean
The following KPIs are generally monitored for various departments int he revenue cycle. E). _______ percentage F). _____ balances G). _____ to collect ratio H). _______ expenses I). ____ ______ expenses E). Denial F). Credit G). Cost H). Charity I). Bad Debt
PERFORMANCE IMPROVEMENT METHODS are used in the act of Incrementally (small steps) exceeding the expectations or requirements of a process through continual _____________ and __________. Enhancements, Refinements
FOCUS – PDCA A). F-____ a process improvement opportunity B). O-_____ a team who understands the process C). C-_____ the current knowledge of the process D). U-_____ the root cause of the poor outcome E). S-____ the 'P-D-C-A' cycle A). F-ind B). O-rganiza C). C-larify D). U-ncover E). S-tart
i. P-_______ ii. D-________ iii. C-_______ iv. A-________ i. P-lan ii. iii. D-o C-heck iv. A-ct
SIX SIGMA is a processing blending _________________ wisdom with proven _____________ tools. Organizational, Statistical
A). The ultimate goal is to create ______ for the customer and provider. B). It measures 'defects' and attempts to eliminate them to get as close to "_____ _______" as possible. C). A defect is defined as failing to deliver what the _______/_______ wants. A). WealthB). Zero DefectC). Customer/Patient
LEAN focuses on eliminating ____-______ added steps and activities in a process. Non-Value
PROCESS ENGINEERING is an improvement technique that involves the fundamental rethinking and radical _______ of business processes to achieve _________ improvements. Redesign, Dramatic
A). Its goal is to be __________ (extreme)B). ___________ (non incremental)C). ______________ (non-traditional) A). RadicalB). DramaticC). Contemporary
PERFORMANCE IMPROVEMENT TOOLS include ____ ______ and ______ maps. Flow Charts, Process
____ ______ are graphical representations of activities that make up a process. By identifying each step in a process, you can analyze and possibly improve it. Flow Chart
___________ ____ is a graphical picture of the actual workflow of a company. This helps clarify who is responsible for a step or task in the process. Process Map
PATIENT ACCESS TRAINING MODELS for patient access staff are: A). _____ __ computer training B). ____ classroom training C). ___ to ____ training D). CBT _____ _____ _____ E). Self _____ ______ F). ____ Playing G). _____________ A). Hands on B). Formal C). Peer to Peer, D). Computer Based Training E). Paced Training F). Role G), Experimental
PATIENT ACCESS TRAINING MODULES help staff learn various systems and processes. Helpful Topics are: A). Computer ______ Training B). _____ Service Standards C). ______ verification D). Pre-___________ E). __________ patient liability A). Systems B). Customer C) Insurance D). Certification E). Calculating
F). overview of healthcare __________ G). __________/Medicaid H). _______ Care I). ________ Cycle Operations J). _______ Terminology K). _________ I). Regulations such as ______ M). __________, etc. F). Finance G). Medicare H). Managed I). Revenue J). Medical K). Scheduling I). HIPAA M). EMTALA
Due to the complexities of the content, most training should be conducted in a ________ with _____ __ systems and role playing. Classrooms, Hands On
A). After training, competence should be demonstrated through _______ and ________ exams. B). ________ _______ will assist in identifying additional training needs or areas of focus. A). Written, PracticalB). Quality Review
A standardized requirement for an employee to properly perform a specific job is known as _____________. Competence
A). It encompasses knowledge, _______ and ______ utilized to improve performance. B). It is the state or quality of being adequately _______ to perform a specific role. A) Skills, Behavior B). Qualified
The two types of Competencies are B_________ and T____________. Behavioral, Technical
___________ competencies include registering, verifying, calculating deposits, etc and are typically learned in an _________ environment or on the job. Technical, Education
____________ competencies are adaptability, decisiveness, integrity, dealing with pressure, etc. and are learned through _____ experiences and our _________ patterns. Behavioral, Life, Behavioral
____________ COMPETENCIES encompass knowledge, skills, attitudes, and actions that distinguish _______ performers. Behavioral, Excellent
A). identify behaviors that enable employees to achieve ________ performance. B). and provide a ____ ____ to understanding how to achieve success as a patient access associate. A). SuperiorB). Road Map
Label the following as either a Behavioral Competence (BC) or a Technical Competencies (TC): A). ___ Knowledge of regulatory standards such as EMTALA, HIPAA, etc. B). __Knowledge of basic CPT?ICD coding A). TCB). TC
C). Uses time wisely and knows how to prioritize tasks accordingly and accomplish several tasks at once. D). ___ Proficient at using Microsoft Word, Excel, and PowerPoint C). BCD). TC
E). ___ Pays attention and understands when others are talking. Gives the patient nonverbal and verbal signs they are listening. F). ___Able to stay calm and professional and maintain a positive manner during difficult or stressful situations. E). BCF). BC
G). ___ Knows and understands medical/insurance terminology and requirements H). ___ Able to work without close supervision by ensuring that tasks are finished on time without error and up to quality standards. G). TCH). BC
I). ___ The ability to develop, maintain, and strengthen partnerships with others inside or outside the organization J). ____ Identifies what needs to be done and does it before being asked or the situation needs it. I). BCJ). BC
BENCHMARKING is an improvement tool where a company ______ its performance or processes against other _______ best practices. Measures, Companies
It determines how those companies ______ their performance levels, and uses the information to improve its own ___________. Achieve, Performance
BENCHMARKING is a _______ process where a company measures and ________ all its functions, systems and practices against strong competitors, identifying ______ gaps, and striving to achieve a ________ advantage. Continuous, Compares, Quality, Competitive
Benchmarking should be used on a ________ basis because best practices are always _________. Continual, Evolving
BENCHMARKS that compare different departments within the same organization are called ______ benchmarking. Internal
When a company benchmarks or compares itself with another company that provides the same service, it is known as _________ benchmarking. External
Benchmarking that compares a similar function or process in another industry is known as __________ benchmarking. Functional
BALANCED SCORECARD is an organizational framework for implementing and managing ________ at all levels by linking OBJECTIVES, INITIATIVES, and MEASURES to an organizations strategy. Strategy
BALANCED SCORECARD A). Upfront Cash Collections B). Admission/Registration Productivity C). Patient Satisfaction D). Denial Rate E). Physician, Patient, and Employee satisfaction.
The measure of labor output or production is known as ____________. Productivity
A ______________ measurement measures QUALITY of registrations completed such as accuracy rate. Qualitative
A _____________ measurements measures QUANTITY such as number of registration completed per hour. Quantitative
PRODUCTIVITY MEASURES should measure both ________ and ________. Quantity, Quality
Every day, it becomes more obvious that excellent _______ outcomes alone DO NOT increase the likelihood of repeat customers. (Think about restaurants). Clinical
A). Great care includes the complicated series of ______ connections between staff and patients. B). In summary, increasing the _______ and ______ (number) of human interactions improving healing. A). HumanB). Quality, Frequency
The federal government has realized that _________ to and _______ on patients' feedback improves the quality of healthcare. Listening, Acting
Hospitals that have _______-_________ care will have a business advantage as transparency (newspapers publishing reports) and public reporting garner more attention. Patient-Centered
__________ are also adopting patient satisfaction quality metrics and are moving toward reimbursing hospitals with low patient satisfaction LESS than hospitals with higher rates. Payers
The national trend in patient satisfaction has continued its steady upward climb, and in the face of ___________ and heavy _________ it becomes a competitive necessity for individual hospitals to continually improve the ____ of care they provide. Transparency,Competition, Quality
Studies show that satisfied patients are more likely to adhere to medical _______ and that emotional stress during the healthcare experience can _______ recovery. Advice, Hinder
The primary goal of a healthcare provider is to establish ______ ______ which leaves the patient with a positive feeling about the care they received. Patient Loyalty
_________ more so that satisfaction is statistically linked to an organization's financial and growth metrics and overall success. Loyalty
__________ REFERRAL patterns drive patient admissions and revenue and significantly impact a hospital's reputation. Physician
______ ______ is a process for checking the work performed by one's equals to ensure it meets specific criteria. Peer Review
The goal is to verify whether the work satisfies the ________ for review, identify any _______, and provide ____________ for improvements. Specifications, Deviation, Suggestions

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