KPIs and Quality Assurance Flashcards
6 cards from real CHAA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 KPIs and Quality Assurance flashcards as text
What is the significance of 'first pass yield' in the context of claim processing?
Answer: The percentage of claims that are paid on first submission without rejection or denial
First pass yield measures the percentage of claims paid on initial submission, reflecting the cumulative quality of front-end processes including registration accuracy.
Which quality assurance tool uses a fishbone format to identify root causes of patient access issues?
Answer: Ishikawa (cause-and-effect) diagram
The Ishikawa diagram organizes potential root causes into categories (people, process, technology, environment) to systematically analyze quality problems.
What role does benchmarking play in patient access quality assurance?
Answer: Comparing internal performance metrics against industry standards and peer organizations to identify improvement opportunities
Benchmarking against industry standards (NAHAM AccessKeys, HFMA MAP) provides context for internal metrics and identifies performance gaps.
How should patient access departments measure employee productivity?
Answer: Through a balanced scorecard including volume, accuracy, patient satisfaction, and compliance metrics
A balanced scorecard approach prevents gaming any single metric and ensures productivity is measured alongside quality, service, and compliance.
What is a Service Level Agreement (SLA) in the context of patient access operations?
Answer: A documented commitment to specific performance standards such as answer times, wait times, and resolution rates
SLAs define measurable service commitments that patient access departments agree to maintain, providing accountability and clear expectations.
Why is tracking 'avoidable days' important as a KPI related to patient access?
Answer: It tracks inpatient days that could have been prevented with timely authorization, accurate registration, or proper insurance verification
Avoidable days caused by front-end issues like missing authorizations or incorrect insurance cost the facility unreimbursed bed days.