CCA Exam Prep Domain 2 Questions & Answers 2023/2024
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Course
CCA
Institution
CCA
CCA Exam Prep Domain 2 Questions & Answers 2023/2024
Allowable fee - ANSWER-Average or maximum amount the third-party payer will reimburse providers for the service
Block grant - ANSWER-It is a fixed amount of money given or allocated for a specific purpose. Ex. Medicare's payment system fo...
CCA Exam Prep Domain 2 Questions &
Answers 2023/2024
Allowable fee - ANSWER-Average or maximum amount the third-party payer will reimburse providers for
the service
Block 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 third-party 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
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