CCA Exam Prep Domain 2
2023
Allowable fee - Answer-Average or maximum amount the third-party payer will
reimburse providers for the service
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... [Show More] grant - Answer-It is a fixed amount of money given or allocated for a specific
purpose. Ex. Medicare's payment system for home health services are consolidated into
the single payment
Capitated payment method - Answer-It is a method of payment for health services in
which the third-party payer reimburses providers a fixed, per capita amount for a period.
"Per capita" means "per head"
Case-based payment - Answer-Type of prospective payment method in which the thirdparty payer reimburses the provider a fixed, preestablished payment for each case
Adjacent episodes of care - Answer-Episodes of home health that are contiguous and
separated by no more than 6 days
Adjudication - Answer-The determination of the reimbursement payment based upon
the member's insurance benefits
Adverse selection - Answer-Enrollment of excessive proportion of persons with poor
health status in a healthcare plan or healthcare organization
RBRVS - Answer-The federal government's payment system for physicians. It is a
system of classifying health services based on the cost of furnishing physicians'
services in different settings, the skill and training levels required to perform the
services, and the time and risk involved
Clustering - Answer-Coding or charging one or two middle levels of service codes
exclusively
AHA's Coding Clinic for ICD-10 CM/PCS - Answer-It allows coders to submit a request
for coding advice through the coding publication. It is the only official publication for
ICD-10-CM/PCS
Major diagnostic categories - Answer-MS diagnostic-related groups are organized into
this
Clinical Risk Group - Answer-Capitated, prospective payment system that predicts
future healthcare expenditures for populations
Code range - Answer-Applicable set of diagnosis or procedure codes
Coding Compliance plan - Answer-A component of an HIM compliance plan or a
corporate compliance plan that focuses on the unique regulations and guidelines with
which coding professionals must comply
Cognitive - Answer-Related to mental abilities, such as talking, memory, and problem
solving
Coinsurance - Answer-Cost-sharing in which the policy or certificate holder pays a
preestablished percentage of eligible expenses after the deductible has been met. The
percentage may vary by type or site of service
Community rating - Answer-Method of determining healthcare premium rates by
geographic area rather than by age, health status, or company size. This method
increases the size of the risk pool. Costs are increased to younger, healthier individuals
who are, in effect, subsidizing older or less healthy individuals
Comorbidity - Answer-Preexisting condition that, because of its presence with a specific
diagnosis, causes an increase in length of stay by at least one day in approximately 75
percent of the cases
Compliance threshold - Answer-Minimum percentage of inpatients receiving intensive
rehabilitation services for 13 qualifying conditions to be classified as an inpatient
rehabilitation facility
Complication - Answer-A medical condition that arises during an inpatient
hospitalization. A condition that arises during the hospital stay that prolongs the length
of stay at least one day in approximately 75 percent of the cases
Accounts receivable - Answer-Department in a healthcare facility that manages the
amounts owed to the facility by customers who have received services but whose
payment is made at a later date... [Show Less]