CHAA Exam — Questions and Answers

Question 1: What is the primary purpose of obtaining a pre-authorization from an insurance company?

To verify the patient's demographic information.
To schedule the patient's appointment with a specialist.
To determine medical necessity and secure payment approval from the payer. (Correct answer)
To provide the patient with a cost estimate for the service.

Correct answer: To determine medical necessity and secure payment approval from the payer.

Pre-authorization, also known as prior approval, is a process used by insurance companies to determine if a prescribed procedure, service, or medication is medically necessary. Securing this approval before the service is rendered is crucial to ensure the insurance plan will cover the cost. Without it, the claim may be denied, leaving the patient or provider responsible for the full amount.

Question 2: What is retrospective authorization, and when is it used?

Authorization obtained after services are rendered, typically for emergencies or when prior authorization couldn't be obtained in time (Correct answer)
A type of insurance plan
Authorization before a planned service
It eliminates authorization needs

Correct answer: Authorization obtained after services are rendered, typically for emergencies or when prior authorization couldn't be obtained in time

Retrospective authorization is sought after services are provided in emergencies or urgent situations.

Question 3: When collecting a copayment at time of service, which best practice should patient access staff follow?

Skip collection if the patient seems upset
Add the copay to the final bill without collecting upfront
Collect the copay at check-in and provide a receipt (Correct answer)
Wait until after the appointment to discuss payment

Correct answer: Collect the copay at check-in and provide a receipt

Collecting copayments at check-in is standard best practice and reduces the cost of back-end billing; a receipt documents the transaction for both parties.

Question 4: A patient formally complains that they were not given information about their rights at admission. This type of complaint is classified as:

A billing dispute
An incident report
A peer review matter
A patient grievance (Correct answer)

Correct answer: A patient grievance

A written or verbal complaint by a patient or their representative about the quality of care or the violation of patient rights is defined as a patient grievance under CMS regulations.

Question 5: What is medical identity theft, and why is it particularly dangerous?

It only affects the victim's credit score
It involves using someone's personal information to obtain medical services, which can corrupt the victim's medical record with incorrect information leading to harmful treatment decisions (Correct answer)
It is limited to stealing prescriptions
It only occurs with paper records

Correct answer: It involves using someone's personal information to obtain medical services, which can corrupt the victim's medical record with incorrect information leading to harmful treatment decisions

Medical identity theft is uniquely dangerous because it can corrupt medical records with potentially life-threatening incorrect information.

Question 6: Under the HIPAA Breach Notification Rule, if a breach affects 500 or more individuals in a state, the covered entity must notify which of the following within 60 days of discovery?

The state governor's office and local law enforcement
The Department of Justice and the FBI
HHS and prominent media outlets in the affected area, in addition to affected individuals (Correct answer)
The affected patients only

Correct answer: HHS and prominent media outlets in the affected area, in addition to affected individuals

For breaches affecting 500 or more individuals in a state or jurisdiction, covered entities must notify: the affected individuals, the Secretary of HHS (immediately), and prominent media outlets serving that state — all within 60 days of discovering the breach.

Question 7: During the revenue cycle, what is the role of coordination of benefits (COB)?

To verify that a claim has been submitted without errors
To assign diagnosis codes to clinical documentation
To calculate the patient's estimated cost share before a procedure
To determine which payer is primary when a patient has multiple insurance plans (Correct answer)

Correct answer: To determine which payer is primary when a patient has multiple insurance plans

Coordination of benefits (COB) is the process of determining the order in which multiple insurance plans pay a claim. The primary payer pays first, and the secondary payer may cover remaining eligible balances, preventing overpayment.

Question 8: What is the purpose of the Medicare Secondary Payer (MSP) questionnaire administered during registration?

To identify whether another insurer should be the primary payer before Medicare (Correct answer)
To enroll the patient in a Medicare Advantage plan
To determine if the patient qualifies for Medicare Part D
To verify the patient's Medicare eligibility

Correct answer: To identify whether another insurer should be the primary payer before Medicare

The MSP questionnaire identifies situations where Medicare should be the secondary payer, such as when the patient has employer group health coverage.

Question 9: What is the primary purpose of a remittance advice (RA) in the revenue cycle?

To authorize a procedure before it is performed
To document the patient's medical history for billing purposes
To notify the patient of their scheduled appointment
To explain the payment determination made by a payer on a submitted claim (Correct answer)

Correct answer: To explain the payment determination made by a payer on a submitted claim

A remittance advice is a document sent by the payer alongside payment that details how each claim was adjudicated, including amounts paid, denied, or adjusted. It allows the provider to reconcile payments and identify discrepancies.

Question 10: What is an HMO, and what are its key characteristics for patient access?

No restrictions on provider choice
Requires a PCP, referrals for specialists, and in-network providers, making referral and network verification critical (Correct answer)
A type of government insurance
Only covers preventive care

Correct answer: Requires a PCP, referrals for specialists, and in-network providers, making referral and network verification critical

HMOs restrict coverage to in-network providers and typically require PCP referrals.

Question 11: A minor patient, aged 15, arrives for reproductive health services and specifically requests that their parents not be informed. In most U.S. states, the Patient Access associate should:

Request a court order before proceeding
Proceed with registration and respect the minor's right to confidentiality for certain services (Correct answer)
Refuse to register the patient without parental consent
Notify the parents immediately because the patient is a minor

Correct answer: Proceed with registration and respect the minor's right to confidentiality for certain services

Most states grant minors the right to consent to and receive confidential reproductive, mental health, and substance abuse services without parental involvement.

Question 12: What role does the Emergency Department play in patient identification challenges?

The ED uses different standards
Identification is not required in emergencies
The ED faces unique challenges including unconscious patients, patients without ID, high volumes, and time pressure increasing misidentification risks (Correct answer)
The ED has no identification challenges

Correct answer: The ED faces unique challenges including unconscious patients, patients without ID, high volumes, and time pressure increasing misidentification risks

The ED presents unique identification challenges due to the nature of emergency presentations.

Question 13: A patient's out-of-pocket maximum has been met for the year. What does this mean for subsequent covered services?

The patient must switch to a different plan
The patient owes 100% of costs
The patient's deductible resets immediately
The insurance company pays 100% of covered costs for the remainder of the benefit year (Correct answer)

Correct answer: The insurance company pays 100% of covered costs for the remainder of the benefit year

Once a patient reaches their out-of-pocket maximum, the insurer covers 100% of all covered in-network services for the rest of the plan year.

Question 14: What information is required when submitting a pre-authorization request?

Patient demographics, insurance information, diagnosis codes, procedure codes, clinical documentation, and provider information (Correct answer)
Only patient name and insurance number
The patient's payment history
Only a verbal request

Correct answer: Patient demographics, insurance information, diagnosis codes, procedure codes, clinical documentation, and provider information

Pre-authorization requires comprehensive patient, insurance, clinical, and provider information.

Question 15: An authorization was approved for dates of service March 1-31, but the patient's surgery is rescheduled to April 10. What should access staff do?

Contact the payer to extend or obtain a new authorization before the new date (Correct answer)
Bill the patient directly for the procedure
Proceed, since the authorization number is still on file
Change the date of service on the claim to March 31

Correct answer: Contact the payer to extend or obtain a new authorization before the new date

Authorizations are valid only for the approved date range, so a rescheduled service outside that window requires an extension or new authorization.

Question 16: A patient qualifies for charity care but also has Medicaid. How should this be handled?

Bill Medicaid first as the primary payer, then apply charity care to remaining balance if applicable (Correct answer)
Let the patient choose which program to use
Apply charity care first since it covers more
Deny charity care since they have Medicaid

Correct answer: Bill Medicaid first as the primary payer, then apply charity care to remaining balance if applicable

Insurance must always be billed as the primary payer before applying charity care or financial assistance to any remaining patient responsibility.

Question 17: What does the suffix '-ology' mean?

Surgical incision into
The study of (Correct answer)
Abnormal softening of
Surgical fixation of

Correct answer: The study of

'-Ology' means the study of a subject. Examples include cardiology (study of the heart), neurology (study of the nervous system), and pathology (study of disease).

Question 18: During registration, a patient states they sometimes get dizzy and have fallen before. What is the best action for the Healthcare Access Associate to take?

Ask a family member to watch them closely.
Tell the patient to be more careful.
Follow the facility's fall prevention protocol, which may include offering a wheelchair and notifying staff. (Correct answer)
Make a note in the chart but take no other action.

Correct answer: Follow the facility's fall prevention protocol, which may include offering a wheelchair and notifying staff.

Patient safety is a top priority. When a patient identifies themselves as a fall risk, the associate must take action to mitigate that risk and communicate it to the clinical team. Following the facility's fall prevention protocol, which may include providing a wheelchair or notifying clinical staff, is the appropriate response to ensure the patient's safety.

Question 19: What is the function of a remittance advice (RA) in the revenue cycle?

It records the charges entered by clinical staff after a service
It authorizes a provider to perform a clinical procedure
It documents the patient's consent for treatment
It explains how a payer processed a claim and what amount was paid or denied (Correct answer)

Correct answer: It explains how a payer processed a claim and what amount was paid or denied

A remittance advice is sent by the payer to the provider after processing a claim. It details payment amounts, adjustments, and denial reasons, allowing the billing team to reconcile accounts.

Question 20: Effective communication between Patient Access and clinical departments like Nursing is most critical for which reason?

Ensuring patient safety and continuity of care (Correct answer)
Improving the hospital's marketing efforts
Reducing the workload for nurses
Maximizing hospital revenue

Correct answer: Ensuring patient safety and continuity of care

Accurate patient identification and registration information are fundamental to patient safety. Clear communication ensures that the right patient receives the right treatment, preventing potentially catastrophic medical errors.

Question 21: A patient's allowed amount is $1,000, they have $200 of deductible remaining, and their plan pays 80% after the deductible. What is the patient's responsibility?

$360 (Correct answer)
$200
$300
$400

Correct answer: $360

The patient pays the $200 deductible plus 20% of the remaining $800 ($160), totaling $360.

Question 22: When submitting a prior authorization request, which code set is used to communicate the patient's diagnosis supporting medical necessity?

ICD-10-CM (Correct answer)
CPT
HCPCS Level II
Revenue codes

Correct answer: ICD-10-CM

ICD-10-CM diagnosis codes describe the patient's condition and justify medical necessity for the requested service.

Question 23: What does the term “co-insurance” refer to?

The fixed amount paid by the patient at the time of service
The percentage of healthcare costs shared between the patient and the insurance provider (Correct answer)
The total cost of the service
The secondary insurance policy held by the patient

Correct answer: The percentage of healthcare costs shared between the patient and the insurance provider

Co-insurance refers to the percentage of healthcare costs that the patient shares with their insurance provider after the deductible has been met. For example, if a plan has 20% co-insurance, the patient pays 20% of the bill, and the insurance company pays the remaining 80%.

Question 24: While registering a patient, you notice the photo on their driver's license does not appear to match the person standing in front of you. What is the most appropriate next step?

Ask for a second form of photo identification and follow facility protocol. (Correct answer)
Ignore the discrepancy to avoid offending the patient.
Refuse service and ask the patient to leave immediately.
Accuse the patient of using a fake ID.

Correct answer: Ask for a second form of photo identification and follow facility protocol.

Discrepancies between a photo ID and the patient could indicate medical identity theft. Following the facility's specific protocol, which often involves asking for a secondary form of photo ID and discreetly notifying a supervisor, is the correct and safest course of action.

Question 25: What is the primary purpose of charge capture in the revenue cycle?

To collect patient copayments
To submit claims to insurance companies
To verify patient identity
To record all billable services provided to a patient (Correct answer)

Correct answer: To record all billable services provided to a patient

Charge capture is the process of recording all services, procedures, and supplies provided to a patient so they can be billed accurately. Missing charges lead to revenue leakage. This step bridges clinical documentation and billing.

Question 26: What is the relationship between patient access and the revenue cycle?

Revenue cycle only begins after patient discharge
Patient access and revenue cycle are completely separate departments
Patient access has no impact on the revenue cycle
Patient access is the front end of the revenue cycle, where data accuracy determines downstream billing success (Correct answer)

Correct answer: Patient access is the front end of the revenue cycle, where data accuracy determines downstream billing success

Patient access initiates the revenue cycle, and errors at this stage compound through billing, coding, and collections.

Question 27: What is the role of medical coding in the revenue cycle?

To create passwords for the billing system
To translate clinical documentation into standardized codes that drive reimbursement (Correct answer)
To encrypt patient medical records for security
To code patient satisfaction surveys

Correct answer: To translate clinical documentation into standardized codes that drive reimbursement

Medical coding translates clinical diagnoses, procedures, and services documented in the medical record into standardized alphanumeric codes (ICD-10, CPT, HCPCS) that are used for claim submission and reimbursement. Accurate coding is essential for proper payment, compliance, and data reporting. Coding errors can result in claim denials, underpayment, or fraud allegations.

Question 28: Which of the following actions would be considered a violation when collecting patient financial information?

Screening for Medicaid eligibility
Offering a payment plan
Disclosing a patient's financial information to unauthorized third parties (Correct answer)
Collecting a copay at time of service

Correct answer: Disclosing a patient's financial information to unauthorized third parties

Sharing a patient's financial or health information with unauthorized individuals violates HIPAA and patient privacy rights, regardless of the context.

Question 29: During the registration workflow, which step involves confirming that a patient's insurance plan has authorized a planned procedure before the service is rendered?

Eligibility verification
Claims adjudication
Benefits coordination
Prior authorization (Correct answer)

Correct answer: Prior authorization

Prior authorization (also called pre-authorization or pre-certification) is the insurer's formal approval that a specific service is medically necessary and covered — it must be obtained before the procedure to avoid claim denials, and is a distinct step from simply verifying active eligibility.

Question 30: What is the appropriate action when a healthcare access associate is unable to confirm a patient's insurance eligibility prior to service?

Document the failed verification attempts, inform the patient of potential financial responsibility, and consider collecting a deposit (Correct answer)
Proceed with service, assuming the coverage listed on the card is active
Submit the claim anyway and flag it for manual review after the appointment
Refuse service until the insurance company can be reached during business hours

Correct answer: Document the failed verification attempts, inform the patient of potential financial responsibility, and consider collecting a deposit

When eligibility cannot be confirmed, staff should document all verification attempts, clearly communicate the uncertainty of coverage to the patient, and collect a good-faith deposit or establish a payment arrangement. This protects both the patient and the organization from unexpected financial liability.

Question 31: What is the primary difference between Medicare Part A and Medicare Part B coverage?

Part A is for over 65, Part B is for under 65
Part A covers inpatient hospital, skilled nursing, hospice, and home health; Part B covers outpatient services, physician visits, and preventive care (Correct answer)
No difference between Part A and Part B
Part A covers drugs and Part B covers hospital stays

Correct answer: Part A covers inpatient hospital, skilled nursing, hospice, and home health; Part B covers outpatient services, physician visits, and preventive care

Part A focuses on inpatient/facility care and Part B on outpatient/professional services.

Question 32: Which federal program provides financial assistance to low-income patients who do not qualify for Medicaid?

Charity care / hospital financial assistance programs (Correct answer)
CHIP
Medicare Advantage
COBRA

Correct answer: Charity care / hospital financial assistance programs

Hospitals are required under the ACA to have financial assistance (charity care) policies to help low-income patients who do not qualify for government programs like Medicaid.

Question 33: What is a '270' transaction in the context of eligibility verification?

A patient billing statement
A referral authorization request
An electronic health care eligibility inquiry sent to a payer (Correct answer)
A claim submission form

Correct answer: An electronic health care eligibility inquiry sent to a payer

The 270 transaction is the HIPAA-mandated electronic standard for submitting eligibility inquiries to insurance companies. It contains patient demographic and plan information and is sent to the payer to request verification of coverage. The payer responds with a 271 transaction containing the eligibility details.

Question 34: A major advantage for a patient with a Preferred Provider Organization (PPO) plan compared to an HMO is:

They have no annual deductible.
They are only available to government employees.
They have the flexibility to see out-of-network providers. (Correct answer)
All services are covered at 100% with no copay.

Correct answer: They have the flexibility to see out-of-network providers.

The defining feature of a PPO is flexibility. Members can see providers both in-network and out-of-network without a referral, though their out-of-pocket costs (copays, coinsurance) are typically much lower when they stay in-network.

Question 35: A self-pay patient cannot afford their estimated bill. What financial assistance options should the access associate discuss?

Suggest the patient seek care elsewhere
Payment plans, sliding fee scales, charity care applications, and Medicaid eligibility screening (Correct answer)
No options exist for self-pay patients
Only payment plans since charity care is rare

Correct answer: Payment plans, sliding fee scales, charity care applications, and Medicaid eligibility screening

A comprehensive financial counseling approach includes multiple options to help patients access care while meeting their financial obligations.

Question 36: What is the COB order when a patient has auto insurance liability and commercial health insurance?

Patient decides
Commercial is always primary
Both split equally
Auto insurance is typically primary for accident-related treatment, with commercial health insurance secondary (Correct answer)

Correct answer: Auto insurance is typically primary for accident-related treatment, with commercial health insurance secondary

For accident-related injuries, auto insurance is typically primary.

Question 37: What does the suffix '-itis' indicate?

Tumor or mass
Condition of blood
Inflammation (Correct answer)
Surgical repair

Correct answer: Inflammation

The suffix '-itis' means inflammation. Common examples include appendicitis (inflammation of the appendix), bronchitis (inflammation of the bronchial tubes), and arthritis (inflammation of the joints). This is one of the most frequently encountered suffixes in medical documentation.

Question 38: How many characters make up the Medicare Beneficiary Identifier (MBI) that replaced the SSN-based HICN?

9
10
11 (Correct answer)
12

Correct answer: 11

The MBI is an 11-character randomly generated alphanumeric identifier.

Question 39: What is the purpose of an 'appointment reminder' workflow in the registration process?

To assign the patient to a specific registration workstation upon arrival
To collect co-pays before the patient arrives at the facility
To verify insurance eligibility in real time at the point of scheduling
To reduce no-show rates and give patients an opportunity to cancel or confirm in advance (Correct answer)

Correct answer: To reduce no-show rates and give patients an opportunity to cancel or confirm in advance

Appointment reminder systems (phone calls, texts, or patient portal messages) reduce no-shows by prompting patients to confirm attendance or cancel early enough for the slot to be reallocated, improving access for other patients and protecting revenue.

Question 40: How does patient access support medication safety through accurate registration?

No connection to medication safety
Accurate registration ensures the right patient gets the right medications by preventing wrong-patient errors and linking allergy history to the correct record (Correct answer)
Only about pharmacy operations
Access staff administer medications

Correct answer: Accurate registration ensures the right patient gets the right medications by preventing wrong-patient errors and linking allergy history to the correct record

Accurate identification and registration are foundational to medication safety.

Question 41: Which patient right, established by the American Hospital Association's Patient Care Partnership, includes access to information about the patient's own health status?

Right to emergency treatment
Right to privacy
Right to refuse treatment
Right to be informed (Correct answer)

Correct answer: Right to be informed

The right to be informed ensures patients receive clear, complete information about their diagnosis, treatment options, and health status to support their decision-making.

Question 42: An established patient arrives for an appointment but refuses to provide their photo ID, stating that the staff should know them by now. What is the best response?

Ask the patient to write a letter of complaint to management.
Politely explain that it is a hospital policy to verify identity for their protection at every visit. (Correct answer)
Proceed with registration without the ID to maintain patient satisfaction.
Refuse to register the patient until they comply with the request.

Correct answer: Politely explain that it is a hospital policy to verify identity for their protection at every visit.

Patient identification must be confirmed at every encounter, regardless of how familiar the patient is. Politely explaining that this is a universal policy to protect the patient's identity and ensure their medical safety is the best approach to gain cooperation while reinforcing security protocols.

Question 43: A patient presents to the ED and needs immediate admission but has no identification. How should access coordinate with clinical staff?

Wait until the patient is discharged to register
Register under a random name
Create a temporary record with available information, coordinating with clinical staff for identification as the patient is stabilized (Correct answer)
Refuse to register the patient until ID is produced

Correct answer: Create a temporary record with available information, coordinating with clinical staff for identification as the patient is stabilized

EMTALA requires treatment regardless of identification status; access creates a temporary record and works to identify the patient through clinical coordination.

Question 44: A provider is classified as 'in-network' with a patient's insurer. What is the primary financial significance of this status for the patient?

The provider has agreed to discounted contracted rates, reducing the patient's out-of-pocket costs (Correct answer)
The patient owes no cost-sharing at all
The claim is automatically approved without prior authorization
The patient's deductible does not apply to services received

Correct answer: The provider has agreed to discounted contracted rates, reducing the patient's out-of-pocket costs

In-network providers have signed contracts agreeing to negotiated (discounted) rates with the insurer. This lowers the allowed amount and, consequently, the patient's cost-sharing compared to out-of-network care.

Question 45: Which document is required before providing a patient with a good faith estimate under the No Surprises Act?

A referral from the primary care physician
Pre-authorization from the insurance company
A scheduled service or a patient request for an estimate (Correct answer)
A signed consent to treat

Correct answer: A scheduled service or a patient request for an estimate

Under the No Surprises Act, facilities must provide good faith estimates to uninsured or self-pay patients upon scheduling or upon request.

Question 46: Under the HIPAA Breach Notification Rule, how soon must a covered entity notify affected individuals after discovering a breach of unsecured PHI?

Within 60 days (Correct answer)
Within 30 days
Within 90 days
Within 24 hours

Correct answer: Within 60 days

The HIPAA Breach Notification Rule requires covered entities to notify affected individuals without unreasonable delay and no later than 60 calendar days after discovering a breach of unsecured PHI.

Question 47: What is the 'wall of shame' in HIPAA enforcement?

The OCR's public online portal listing all reported breaches of unsecured PHI affecting 500 or more individuals (Correct answer)
A physical wall in HHS headquarters
A list of hospitals that failed inspections
A wall displaying employees who violated HIPAA

Correct answer: The OCR's public online portal listing all reported breaches of unsecured PHI affecting 500 or more individuals

The 'wall of shame' is the informal name for the OCR's online Breach Portal, which lists all reported breaches of unsecured PHI affecting 500 or more individuals. The portal includes the entity name, type of breach, number of individuals affected, and submission date. This public reporting provides transparency and serves as a deterrent for non-compliance.

Question 48: A high Average Wait Time for registration is a KPI that directly impacts which of the following?

The hospital's clean claim rate.
Patient satisfaction scores. (Correct answer)
The rate of medical identity theft.
The patient's clinical outcome.

Correct answer: Patient satisfaction scores.

Long wait times are a major source of frustration for patients and can negatively shape their entire perception of the healthcare encounter. This directly impacts patient satisfaction scores, which are important metrics for hospitals regarding quality of care and reimbursement.

Question 49: Which cultural competency practice is most important during patient registration?

Assuming cultural preferences based on the patient's appearance
Asking open-ended questions about communication and care preferences (Correct answer)
Avoiding discussion of cultural needs to prevent offense
Treating all patients identically regardless of cultural background

Correct answer: Asking open-ended questions about communication and care preferences

Open-ended questions allow patients to share their individual preferences without assumptions, supporting person-centered care.

Question 50: What measures should patient access take to protect information on computer screens in public areas?

Only log in when no patients are nearby
No measures needed
Cover screens with physical barriers at all times
Use privacy screens, automatic logoff, screen positioning away from public view, and minimize visible PHI (Correct answer)

Correct answer: Use privacy screens, automatic logoff, screen positioning away from public view, and minimize visible PHI

HIPAA requires reasonable safeguards to protect PHI from incidental disclosure.

Question 51: Which federal program provides coverage for patients with End-Stage Renal Disease (ESRD) regardless of age?

CHAMPVA
Medicaid
TRICARE
Medicare (Correct answer)

Correct answer: Medicare

Medicare covers patients with ESRD regardless of age, making it a special eligibility category outside the typical age-65 requirement.

Question 52: During the registration process, what is the primary reason a registrar collects the patient's insurance card?

To verify coverage, obtain policy details, and confirm the payer's billing address (Correct answer)
To update the patient's emergency contact information
To determine the patient's preferred pharmacy
To calculate the patient's out-of-pocket maximum for the year

Correct answer: To verify coverage, obtain policy details, and confirm the payer's billing address

Collecting the insurance card allows the registrar to capture the payer name, group number, subscriber ID, and billing contact needed to verify active coverage and submit a clean claim.

Question 53: Under HIPAA's Breach Notification Rule, covered entities must notify affected individuals of an unsecured PHI breach within:

60 days of discovery (Correct answer)
180 days of discovery
30 days of discovery
24 hours of discovery

Correct answer: 60 days of discovery

HIPAA requires covered entities to notify affected individuals without unreasonable delay and no later than 60 days following discovery of a breach of unsecured PHI.

Question 54: What is a 'clean claim' in healthcare billing?

A claim with no associated patient balance
A claim submitted with all required data elements and no errors (Correct answer)
A claim that has been sanitized of patient identifiers
A claim that was paid on first submission regardless of accuracy

Correct answer: A claim submitted with all required data elements and no errors

A clean claim contains all required fields, correct codes, and accurate patient/insurance information, allowing processing without additional development.

Question 55: What is 'claims reconciliation'?

Combining multiple claims into one
Comparing submitted claims against payments received to ensure accuracy and identify discrepancies (Correct answer)
Resolving a dispute between two patients
Cancelling previously submitted claims

Correct answer: Comparing submitted claims against payments received to ensure accuracy and identify discrepancies

Claims reconciliation involves comparing submitted claims against the payments and adjustments received to verify that reimbursement is accurate and complete. This process identifies discrepancies such as underpayments, overpayments, and unresolved denials. Regular reconciliation ensures financial accuracy and identifies trends that need attention.

Question 56: What document informs a patient of their financial obligations before services are rendered?

Patient Demographics Form
Explanation of Benefits (EOB)
Assignment of Benefits (AOB)
Financial Responsibility Form (Correct answer)

Correct answer: Financial Responsibility Form

A Financial Responsibility Form is a document that clearly outlines a patient's financial obligations, such as deductibles, co-pays, and co-insurance, before they receive healthcare services. Signing this form ensures the patient is informed and acknowledges their financial commitment, promoting transparency and preventing unexpected bills.

Question 57: How does the Social Security Number factor into patient identification in healthcare?

SSN is never collected in healthcare
SSN is the primary patient identifier in all hospitals
SSN is required by federal law for all registrations
While SSN helps verify identity and is needed for certain billing purposes, its use should be limited due to identity theft risks, and patients cannot be denied care for refusing to provide it (Correct answer)

Correct answer: While SSN helps verify identity and is needed for certain billing purposes, its use should be limited due to identity theft risks, and patients cannot be denied care for refusing to provide it

SSN serves specific purposes but collection should be limited and protected due to identity theft concerns.

Question 58: What is the primary purpose of a financial counselor in the patient access department?

To verify insurance eligibility
To process insurance claims
To schedule patient appointments
To help patients understand their financial obligations and explore payment options (Correct answer)

Correct answer: To help patients understand their financial obligations and explore payment options

Financial counselors educate patients about their estimated costs and assist them in identifying payment options such as payment plans, charity care, or financial assistance programs.

Question 59: What is a write-off in the context of claims adjudication?

Money collected from the patient at time of service
The insurance premium paid by the employer
A penalty charged to providers for late filing
The amount billed above the Medicare fee schedule that must be written off per contract (Correct answer)

Correct answer: The amount billed above the Medicare fee schedule that must be written off per contract

Contractual write-offs (adjustments) represent the difference between the provider's billed charges and the payer's allowed amount per the negotiated contract, which cannot be billed to the patient.

Question 60: What is a Remittance Advice (RA) or Explanation of Benefits (EOB)?

A pre-authorization approval letter
A document from the payer explaining how a claim was processed, what was paid, and why any portion was denied or adjusted (Correct answer)
A charge description master listing service prices
A document sent to patients explaining their insurance deductible

Correct answer: A document from the payer explaining how a claim was processed, what was paid, and why any portion was denied or adjusted

An RA/EOB is the payer's response to a submitted claim that details payment amounts, contractual adjustments, and denial reasons for each billed service.

Question 61: What is the significance of capturing 'guarantor' information during registration?

It identifies the person financially responsible for the account, critical for billing and collections (Correct answer)
Only needed for uninsured patients
It determines the clinical care pathway
It is optional

Correct answer: It identifies the person financially responsible for the account, critical for billing and collections

The guarantor is the person financially responsible for the patient's account, essential for accurate billing and collections.

Question 62: What is the primary purpose of collecting point-of-service (POS) payments?

To reduce accounts receivable days and improve cash flow (Correct answer)
To generate revenue before insurance processes the claim
To verify the patient's identity
To penalize patients for seeking medical care

Correct answer: To reduce accounts receivable days and improve cash flow

POS collections reduce the accounts receivable cycle, improve cash flow, and decrease the cost of post-service collection efforts.

Question 63: What is a 'hard denial' in claims management?

A denial that is final and cannot be overturned without a formal appeal (Correct answer)
A denial caused by incorrect patient demographics
A denial that can be resolved with additional documentation
A denial due to a missing authorization number

Correct answer: A denial that is final and cannot be overturned without a formal appeal

A hard denial represents a final refusal to pay that requires a formal appeal process if the provider believes the denial is incorrect.

Question 64: Which of the following is NOT one of the 18 identifiers that make health information considered Protected Health Information (PHI)?

Patient's medical record number
Patient's date of birth
Patient's telephone number
Patient's blood type alone (Correct answer)

Correct answer: Patient's blood type alone

Blood type by itself is a clinical value not on HIPAA's list of 18 identifiers. Dates, phone numbers, and medical record numbers are all listed identifiers that, combined with health data, create PHI.

Question 65: A patient has both Medicare and a commercial secondary insurance. In what order should claims be processed?

Both simultaneously to speed up payment
Commercial insurance first because it typically pays more
Whichever the patient prefers
Medicare first as primary, then commercial secondary (Correct answer)

Correct answer: Medicare first as primary, then commercial secondary

Medicare coordination of benefits rules establish Medicare as primary when the patient has Medicare plus a commercial plan (with specific exceptions for employer group health plans).

Question 66: What is 'advance directive' documentation during registration?

Asking patients about and documenting the existence of legal documents that express their healthcare wishes in case they cannot communicate, such as living wills and healthcare power of attorney (Correct answer)
Directing patients to advanced services
Advanced scheduling directives
Directions to the hospital

Correct answer: Asking patients about and documenting the existence of legal documents that express their healthcare wishes in case they cannot communicate, such as living wills and healthcare power of attorney

During registration, patient access staff are required to ask patients about advance directives — legal documents that express the patient's wishes regarding medical treatment if they become unable to communicate. These include living wills and healthcare power of attorney. The Patient Self-Determination Act requires hospitals to ask about advance directives during admission and document the patient's response.

Question 67: What is a Service Level Agreement (SLA) in the context of patient access operations?

A legal agreement between the patient and the facility
A contract between the hospital and insurance companies
A documented commitment to specific performance standards such as answer times, wait times, and resolution rates (Correct answer)
A document outlining employee benefits

Correct 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.

Question 68: For a Medicare patient receiving recurring outpatient therapy services, how often should the Medicare Secondary Payer (MSP) questionnaire information be re-verified?

Once per calendar year
Every visit without exception
Only when the patient reports a change
Every 90 days (Correct answer)

Correct answer: Every 90 days

CMS allows recurring outpatient MSP information to be verified once every 90 days.

Question 69: Which term describes the process of verifying that a payer will reimburse for a specific service before it is rendered?

Prior authorization (Correct answer)
Retrospective audit
Coordination of benefits
Concurrent review

Correct answer: Prior authorization

Prior authorization (also called pre-authorization or pre-certification) is the process of obtaining payer approval before delivering a service to confirm coverage and reimbursement, reducing the risk of claim denial.

Question 70: Which term describes the process of verifying that the diagnosis codes submitted on a claim support the medical necessity of the billed procedure?

Medical necessity review (Correct answer)
Claim scrubbing
Charge reconciliation
Coding compliance auditing

Correct answer: Medical necessity review

Medical necessity review evaluates whether the documented diagnosis codes justify the procedure or service billed, ensuring that payers will recognize the clinical appropriateness of the treatment provided.

Question 71: What is interoperability in healthcare information systems?

The physical connection between hospital buildings
The speed at which a single system processes data
The number of users who can log in simultaneously
The ability of different systems to exchange and use data seamlessly (Correct answer)

Correct answer: The ability of different systems to exchange and use data seamlessly

Interoperability enables different healthcare systems to share, receive, and use patient data across organizational and technical boundaries.

Question 72: A patient needs an urgent MRI but the payer's authorization line is closed after hours. What should patient access do?

Bill as self-pay
Tell the patient to go elsewhere
Refuse to schedule until authorization is obtained
Document the urgency, proceed under the urgent authorization protocol, and submit the request next business day (Correct answer)

Correct answer: Document the urgency, proceed under the urgent authorization protocol, and submit the request next business day

Urgent clinical needs should not be delayed for administrative reasons.

Question 73: What does the prefix 'brady-' mean in medical terminology?

Double
Large or enlarged
Rapid or fast
Slow (Correct answer)

Correct answer: Slow

'Brady-' comes from Greek meaning slow. It is used in terms like bradycardia (slow heart rate) and bradypnea (slow breathing rate).

Question 74: During the registration workflow, what is the primary reason a healthcare access associate verifies a patient's insurance eligibility before the appointment?

To assign the patient to a specific hospital bed
To confirm the patient has an active plan that will cover the anticipated services (Correct answer)
To determine the patient's preferred pharmacy
To decide which physician will perform the procedure

Correct answer: To confirm the patient has an active plan that will cover the anticipated services

Verifying insurance eligibility before the appointment confirms that the patient's coverage is active and that the planned services are benefits under that plan, preventing claim denials and unexpected patient liability after care is delivered.

Question 75: A patient calls to schedule an outpatient procedure that requires prior authorization from their insurance plan. What should the access associate do FIRST?

Collect the patient's insurance information and initiate the prior authorization process before confirming the appointment (Correct answer)
Refer the patient directly to the physician's office
Schedule the procedure immediately and obtain authorization later
Ask the patient to contact their insurance company independently

Correct answer: Collect the patient's insurance information and initiate the prior authorization process before confirming the appointment

Prior authorization must be initiated before the procedure is confirmed or performed. Collecting insurance information first and starting the authorization process ensures the service will be covered and prevents claim denials.

Question 76: A living will is BEST described as:

A physician's order limiting resuscitation efforts
A financial document outlining the patient's ability to pay for care
A legal document designating a surrogate healthcare decision-maker
A written record of a patient's wishes regarding specific medical treatments if unable to communicate (Correct answer)

Correct answer: A written record of a patient's wishes regarding specific medical treatments if unable to communicate

A living will is an advance directive that documents a patient's specific wishes about medical treatments (e.g., ventilators, feeding tubes) when they can no longer communicate.

Question 77: What is a registration quality audit and how often should it be performed?

An annual financial audit of the department budget
A systematic review of registration accuracy performed at regular intervals, typically monthly or quarterly (Correct answer)
A one-time review done during employee orientation
A review only performed when errors are discovered

Correct answer: A systematic review of registration accuracy performed at regular intervals, typically monthly or quarterly

Regular registration audits identify error patterns, measure accuracy trends, and provide data for targeted staff coaching and process improvement.

Question 78: What is EMTALA and why is it important to patient access?

An insurance regulation governing pre-authorization
A federal law requiring emergency departments to screen and stabilize all patients regardless of ability to pay (Correct answer)
A state-level licensing requirement for access staff
A billing regulation that determines payment rates

Correct answer: A federal law requiring emergency departments to screen and stabilize all patients regardless of ability to pay

EMTALA (Emergency Medical Treatment and Labor Act) mandates that all patients receive a medical screening exam in the ED regardless of insurance status or ability to pay.

Question 79: What does the suffix '-ology' mean?

Without or lacking
Incision into
The study of (Correct answer)
Excessive condition

Correct answer: The study of

'-Ology' means the study of. Cardiology is the study of the heart, and oncology is the study of cancer. Patient access staff use these specialty names daily when routing patients and verifying referrals.

Question 80: Some healthcare facilities use biometrics for patient identification. Which of the following is an example of a biometric identifier?

Patient's medical record number
Patient's fingerprint (Correct answer)
Patient's insurance card
Patient's home address

Correct answer: Patient's fingerprint

Biometrics are unique physical or behavioral characteristics used for identification. A fingerprint is a classic example of a physical biometric identifier that is unique to each individual and can be used to quickly and accurately pull up the correct patient record.

Question 81: What is the primary purpose of insurance eligibility verification?

To determine the patient's medical diagnosis
To schedule follow-up appointments
To collect the patient's copayment
To confirm that a patient has active insurance coverage and to understand their benefits before services are rendered (Correct answer)

Correct answer: To confirm that a patient has active insurance coverage and to understand their benefits before services are rendered

Insurance eligibility verification confirms that a patient has active coverage under their stated insurance plan and provides details about their benefits, including copays, deductibles, and coverage limitations. Performing this step before services are rendered prevents many claim denials. It is one of the most impactful front-end revenue cycle activities.

Question 82: What is a 'Master Patient Index' (MPI)?

A list of the hospital's top physicians
A patient satisfaction rating system
A database that assigns a unique identifier to each patient and links all their records across the healthcare system to prevent duplicate records (Correct answer)
An index of medical terminology

Correct answer: A database that assigns a unique identifier to each patient and links all their records across the healthcare system to prevent duplicate records

The Master Patient Index is a database that assigns a unique medical record number to each patient and serves as a cross-reference for all patient records across the healthcare system. It prevents duplicate records, ensures patient data integrity, and links encounters across departments and facilities. Maintaining MPI accuracy is a critical patient access function.

Question 83: A patient is identified as a Qualified Medicare Beneficiary (QMB). What can the provider bill the patient for Medicare-covered services?

The full billed charges
Nothing for Medicare cost-sharing (Correct answer)
The Medicare coinsurance only
The Medicare deductible only

Correct answer: Nothing for Medicare cost-sharing

Federal law prohibits providers from billing QMB beneficiaries for Medicare deductibles, coinsurance, or copayments.

Question 84: A patient portal lets patients pre-register, upload insurance cards, and sign consent forms before arriving. What is the main patient access benefit?

It shortens check-in time and lets staff fix data issues before the visit (Correct answer)
It removes the need for a master patient index
It lets patients change their own diagnosis codes
It removes the need to verify insurance

Correct answer: It shortens check-in time and lets staff fix data issues before the visit

Pre-arrival digital intake moves data capture and verification earlier, which shortens lines and catches problems before the patient arrives.

Question 85: What does the suffix '-algia' mean in medical terminology?

Without or absence of
Condition of excess
Pain (Correct answer)
Enlargement

Correct answer: Pain

'-Algia' means pain. It appears in neuralgia (nerve pain), myalgia (muscle pain), and arthralgia (joint pain), helping clinicians describe a patient's chief complaint location.

Question 86: Why is the Master Patient Index (MPI) critical to healthcare information systems?

It tracks employee schedules and payroll
It stores all clinical notes for every patient
It serves as the single source of truth linking a patient to all their records across systems (Correct answer)
It manages medication prescriptions

Correct answer: It serves as the single source of truth linking a patient to all their records across systems

The MPI assigns a unique identifier to each patient and links all encounters, records, and billing data across the enterprise.

Question 87: Why is accurate data entry crucial during patient registration?

To minimize the need for insurance claims
To ensure proper billing, treatment, and compliance (Correct answer)
To comply with patient requests
To reduce the workload of clinical staff

Correct answer: To ensure proper billing, treatment, and compliance

Accurate data entry during patient registration is paramount because it directly impacts proper billing, effective treatment, and regulatory compliance. Incorrect information can lead to denied insurance claims, errors in patient identification or medical records, and potential breaches of privacy regulations, all of which compromise patient care and financial operations.

Question 88: When a patient has both a primary and secondary insurance plan, what process determines which payer is responsible for reimbursement first?

Subrogation
Assignment of Benefits
Prospective Payment
Coordination of Benefits (COB) (Correct answer)

Correct answer: Coordination of Benefits (COB)

Coordination of Benefits (COB) is the process that determines the order in which multiple insurance plans pay when a patient is covered by more than one plan, preventing duplicate payment and ensuring correct billing sequence.

Question 89: What does ADT stand for in healthcare information systems?

Administrative Decision Tool
Admission, Discharge, and Transfer (Correct answer)
Automated Diagnostic Testing
Advanced Data Transmission

Correct answer: Admission, Discharge, and Transfer

ADT tracks patient movement through the facility from admission through discharge and any transfers between units.

Question 90: What is the purpose of an 'encounter form' (also called a superbill) in the registration and scheduling workflow?

To capture diagnosis and procedure codes for billing purposes during or after a visit (Correct answer)
To record a patient's insurance premium payments
To document a patient's full medical history
To schedule follow-up appointments automatically

Correct answer: To capture diagnosis and procedure codes for billing purposes during or after a visit

An encounter form or superbill is a standardized document used to capture the diagnosis (ICD) and procedure (CPT) codes associated with a patient visit, forming the basis for claim submission to insurance payers.

Question 91: What is the purpose of a 'write-off' in healthcare revenue cycle management?

To transfer a balance to collections
To increase a patient's financial responsibility
To adjust or remove a balance the provider has agreed not to collect (Correct answer)
To resubmit a denied claim with corrections

Correct answer: To adjust or remove a balance the provider has agreed not to collect

A write-off is an accounting adjustment that removes a balance from accounts receivable that the provider cannot or has contractually agreed not to collect, such as contractual adjustments with insurers or uncollectable bad debt.

Question 92: A self-pay patient can start the patient-provider dispute resolution process if the final bill is higher than the Good Faith Estimate by at least how much?

$400 (Correct answer)
$100
$1,000
$250

Correct answer: $400

Patients can dispute a bill that is $400 or more above the GFE for any provider or facility. They must start the dispute within 120 days of receiving the bill.

Question 93: A patient's PCP referral has expired. They're at the facility for their specialist appointment. What should patient access do?

Proceed without a valid referral
Cancel and send the patient home
Contact the PCP's office for a new referral, inform the patient, and coordinate with the specialist on timing (Correct answer)
Tell the patient insurance won't cover it

Correct answer: Contact the PCP's office for a new referral, inform the patient, and coordinate with the specialist on timing

An expired referral requires proactive resolution while minimizing care disruption.

Question 94: What is 'prospective payment' in healthcare?

Paying for services after they are provided
A patient paying in advance of each visit
An estimate of future healthcare costs
A payment system where the reimbursement amount is determined before services are rendered based on predetermined rates (Correct answer)

Correct answer: A payment system where the reimbursement amount is determined before services are rendered based on predetermined rates

Prospective payment is a reimbursement method where the payment amount is established before services are rendered, typically based on the patient's condition or procedure. The DRG system for hospital inpatients is the most common example. This contrasts with retrospective payment, where charges are determined after services are provided.

Question 95: An HMO referral authorizes a patient for 3 visits with a cardiologist. The patient arrives for a 4th visit. What should registration staff do?

Verify whether a new or extended referral from the PCP has been issued before the visit (Correct answer)
Register the visit under the existing referral
Bill the visit to the PCP's office
Convert the visit to self-pay without informing the patient

Correct answer: Verify whether a new or extended referral from the PCP has been issued before the visit

Referrals often limit the number of visits, so once exhausted, a new or extended referral from the PCP is needed for coverage.

Question 96: What is the key difference between a pre-authorization and a referral?

A referral is more important
Pre-authorization is insurance approval confirming medical necessity and coverage; a referral is a PCP order directing the patient to a specialist (Correct answer)
They are the same thing
Pre-authorizations are only for hospital stays

Correct answer: Pre-authorization is insurance approval confirming medical necessity and coverage; a referral is a PCP order directing the patient to a specialist

Pre-authorization confirms insurance coverage while a referral directs a patient between providers.

Question 97: What does 'coordination of benefits' (COB) mean and why is it important?

A payer contract negotiation process
A billing method for outpatient services
The process of scheduling multiple providers for one visit
The process that determines which of a patient's multiple insurance plans pays first (primary) and which pays second (secondary) (Correct answer)

Correct answer: The process that determines which of a patient's multiple insurance plans pays first (primary) and which pays second (secondary)

COB rules establish primary and secondary payer order when a patient has multiple plans, preventing duplicate payments and ensuring accurate billing to each payer.

Question 98: What is the purpose of verifying 'pre-certification requirements' during eligibility checks?

To identify which planned services require insurance approval before they can be performed to prevent authorization-related denials (Correct answer)
To verify staff certification status
To verify the patient has completed medical school
To certify that the facility meets safety codes

Correct answer: To identify which planned services require insurance approval before they can be performed to prevent authorization-related denials

Verifying pre-certification requirements during eligibility checks identifies which planned services, procedures, or admissions require prior approval from the insurance company before they can be performed. This proactive step allows sufficient time to obtain authorizations and prevents denials related to missing pre-certifications, which are among the most common and costly denial reasons.

Question 99: During a planned EHR downtime, what should patient access staff do to keep registering patients?

Use the approved downtime forms and enter the data into the system after recovery (Correct answer)
Reuse temporary MRNs from earlier downtime events
Turn patients away until the system is back up
Register patients on a personal spreadsheet and email it to IT

Correct answer: Use the approved downtime forms and enter the data into the system after recovery

Downtime procedures use standardized paper or offline forms, and the data is entered into the system once it is back up so the record stays accurate.

Question 100: When should patient access staff give a Medicare patient an Advance Beneficiary Notice of Noncoverage (ABN)?

Before the service, when the provider expects Medicare may deny it as not medically necessary (Correct answer)
Only for services Medicare never covers by statute
To every Medicare patient at every visit
After Medicare has already denied the claim

Correct answer: Before the service, when the provider expects Medicare may deny it as not medically necessary

An ABN is given before the service when there is a genuine reason to expect Medicare will deny it, usually for medical necessity. It moves financial liability to the patient if the patient chooses to proceed.

Question 101: Which of the following pieces of information is most critical when submitting a pre-authorization request?

The patient's preferred appointment time.
Clinical documentation supporting medical necessity. (Correct answer)
The name of the registration staff member.
The patient's employment history.

Correct answer: Clinical documentation supporting medical necessity.

While all listed information is important, the clinical documentation that supports medical necessity is the most critical component of a pre-authorization request. This documentation, which includes diagnosis codes and physician notes, is what the insurance company uses to determine if the requested service meets their criteria for coverage. Without strong clinical justification, the request will be denied.

Question 102: What is the 'gender rule' in coordination of benefits?

An older COB rule where the father's plan was primary for dependents, largely replaced by the birthday rule (Correct answer)
About gender-based pricing
Only applies to maternity
Determines benefits based on gender

Correct answer: An older COB rule where the father's plan was primary for dependents, largely replaced by the birthday rule

The gender rule was replaced by the birthday rule to eliminate gender-based discrimination.

Question 103: What does the suffix '-ology' mean?

Condition of
Surgical removal
Treatment of
Study of (Correct answer)

Correct answer: Study of

The suffix '-ology' means the study of a particular subject. For example, cardiology is the study of the heart, dermatology is the study of the skin, and radiology is the study of imaging. Patient access staff use department names built on this suffix when routing patients and referrals.

Question 104: What does the prefix 'tachy-' mean in medical terminology?

Rapid or fast (Correct answer)
Below normal
Slow
Around

Correct answer: Rapid or fast

'Tachy-' means rapid or fast. For example, tachycardia refers to an abnormally fast heart rate, which patient access staff may see frequently in admission documentation.

Question 105: A hospital writes off a balance because it is contractually prohibited from billing the patient for the difference between its charge and the payer's allowed amount. This is known as a:

Contractual adjustment (Correct answer)
Bad debt write-off
Charity care adjustment
Administrative denial

Correct answer: Contractual adjustment

A contractual adjustment reduces the billed charge to the payer-allowed amount as required by the provider's contract. Unlike bad debt, it is an expected and pre-agreed reduction, not an uncollectible balance.

Question 106: Which of the following situations would most likely require a pre-authorization before the service is rendered?

A routine blood draw ordered during an office visit
An annual wellness visit with the patient's primary care physician
An emergency room visit following an accident
An elective MRI ordered by a specialist (Correct answer)

Correct answer: An elective MRI ordered by a specialist

Elective diagnostic imaging such as MRIs frequently requires prior authorization from the insurer to confirm medical necessity before the service is performed. Emergency services are generally exempt from pre-authorization requirements.

Question 107: A patient enrolled in an ACA Marketplace plan with advance premium tax credits has missed premium payments. How long is the grace period before coverage can be terminated?

6 months
3 months (Correct answer)
30 days
60 days

Correct answer: 3 months

Enrollees receiving APTC get a 3-month grace period, with the insurer paying claims in the first month and possibly pending claims in months two and three.

Question 108: What is the difference between 'eligibility' and 'benefits verification'?

Benefits verification is only needed for surgical patients
Eligibility is done by the payer, benefits by the provider
Eligibility confirms active coverage, while benefits verification determines specific plan details like deductibles, copays, and covered services (Correct answer)
They are exactly the same thing

Correct answer: Eligibility confirms active coverage, while benefits verification determines specific plan details like deductibles, copays, and covered services

Eligibility verification confirms that a patient has active insurance coverage on a given date. Benefits verification goes deeper, identifying the specific plan details such as deductible amounts, copay requirements, coinsurance rates, coverage limitations, and authorization requirements. Both are important but serve different purposes in the pre-service process.

Question 109: A 67-year-old patient has Medicare and is also covered by an Employer Group Health Plan (EGHP) from their current, active employment. The employer has 50 employees. Which plan is primary?

Medicare
Medicaid
The Employer Group Health Plan (EGHP) (Correct answer)
The plans pay 50/50

Correct answer: The Employer Group Health Plan (EGHP)

According to Medicare Secondary Payer (MSP) rules, if an individual is age 65 or older and covered by an EGHP due to their own or a spouse's current employment with an employer of 20 or more employees, the EGHP is primary. Medicare pays secondary.

Question 110: What does the metric 'days in accounts receivable' (A/R days) measure?

The average number of days it takes to collect payment after a service is rendered (Correct answer)
The total dollar value of unpaid claims currently in the billing system
The number of days a provider has to submit a claim before the filing deadline
The number of days a patient waits before receiving an appointment

Correct answer: The average number of days it takes to collect payment after a service is rendered

Days in A/R is a key revenue cycle KPI that reflects how efficiently a provider collects payments. A lower number indicates faster collections and healthier cash flow.

Question 111: According to The Joint Commission's National Patient Safety Goals, what is the minimum number of patient identifiers that must be used when providing care, treatment, or services?

One
Three
Four
Two (Correct answer)

Correct answer: Two

To reliably identify the individual as the person for whom the service or treatment is intended, at least two identifiers must be used. Acceptable identifiers include the patient's full name and date of birth. Using the patient's room number is not an acceptable identifier.

Question 112: What is the purpose of tracking denial rates by root cause in patient access?

Denial tracking is a billing function only
To identify systemic issues, target training, and implement process improvements that reduce preventable denials (Correct answer)
To penalize staff who make errors
To report to insurance companies

Correct answer: To identify systemic issues, target training, and implement process improvements that reduce preventable denials

Root cause analysis of denials reveals patterns that drive targeted training, process changes, and technology solutions to prevent recurrence.

Question 113: What is the 'birthday rule' in the context of insurance coordination?

Patients get special services on their birthday
Insurance starts on the patient's birthday
When a dependent child is covered by two parents' plans, the parent whose birthday falls earlier in the calendar year has the primary plan (Correct answer)
Patients verify identity every birthday

Correct answer: When a dependent child is covered by two parents' plans, the parent whose birthday falls earlier in the calendar year has the primary plan

The birthday rule determines primary insurance for dependent children when both parents have coverage.

Question 114: Why is tracking 'avoidable days' important as a KPI related to patient access?

It counts the number of days the department is understaffed
It tracks inpatient days that could have been prevented with timely authorization, accurate registration, or proper insurance verification (Correct answer)
It measures vacation days taken by staff
It measures the number of no-show appointments

Correct 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.

Question 115: What is an 'overlay' in patient identification, and why is it more dangerous than a duplicate record?

A cosmetic change to the registration screen
A backup copy of a record
When a patient changes their name
When two different patients' records are merged into one, mixing their medical histories and creating potential for treatment errors (Correct answer)

Correct answer: When two different patients' records are merged into one, mixing their medical histories and creating potential for treatment errors

An overlay combines records of two different patients, creating mixed medical information that can lead to dangerous treatment decisions.

Question 116: On the UB-04 claim, which admission type code means an elective admission?

1
3 (Correct answer)
2
5

Correct answer: 3

UB-04 admission type codes are 1 = Emergency, 2 = Urgent, 3 = Elective, 4 = Newborn, 5 = Trauma.

CHAA Exam

The CHAA exam certifies professionals in patient access services, covering registration, insurance verification, regulatory compliance, and revenue cycle management.

115

Questions

120 min

Time Limit

70%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds

These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

naham.org — Eligibility, exam format, passing score, time limit, score validity, test delivery, fees, registration, retake fee, score release · verified Oct 2026