CCM Exam Question and answer rated A+ 2023

CCM Exam Question and answer rated A+ 2023Accountable Care Organization (ACO) A set of healthcare providers including primary care physicians, specialists, and hospitals that work together collaboratively and accept collective accountability for the cost and quality of care delivered to a population of patients. Actionable tort A legal duty, imposed by statute or otherwise, owing by defendant to the one injured Actual value is also referred to as Real value is also referred to as Actual value Measures the worth one derives from using or consuming a good, product, service or an item, and represents the utility of the good, product, service, or item. Actuarial study Statistical analysis of a population based on its utilization of healthcare services and demographic trends of teh population. Results used to estimate healthcare plan premiums or costs. Adhesive contract An agreement between two parties where one party with stronger bargaining power sets the terms and conditions and the other party, which is the weaker of the two with little to no ability to negotiate, must adhere to the contract and is placed in a "take it or leave it" position. Adjusted Clinical Group (ACG) System The system clusters clients into homogenous groups based on a unique approcach to measuring morbidity to ultimately improve accuracy and fairness in evaluating healthcare provider performance, identifying clients at high risk, forecasting healthcare utilization, and setting equitable payment structure and rates for the providers of care. Administrative Services Only (ASO) An insurance company or third-party administrator that delivers administrative services to an employer group. This usually requires the employer to be at risk for the cost of healthcare services provided. Admission certification A form of utilization review in which an assessment is made of the medical necessity of a client's admission to a hospital or other inpatient facility. It ensures taht clients requiring a hospital-based level of care and length of stay appropriate for the admission diagnosis are usually assigned and certified and payment for teh services are approved. Admission review A review that occurs within 24 hours of a client's admission to a healthcare facility or according to the time frame required in the contractual agreement between healthcare provider and the health insurance plan. Adverse events Any untoward occurrences, which under most conditions are not natural consequences of the client's disease process or treatment outcomes. Aggregated Diagnosis Groups (ADGs) A grouping of diagnosis codes that are similar in terms of severity and likelihood of persistence in a client's health condition over time. AHRQ Agency for Healthcare Research and Quality Ambulatory Payment Classification (APC) System An encounter-based classification system for outpatient reimbursement, including hospital-based clinics, emergency departments, observation, and ambulatory surgery. Payment rates are based on categories of services that are similar in cost and resource utilization. Bad faith Generally involving actual or constructive fraud, or a design to mislead or deceive another. Beneficence Compassion; taking positive action to help others; desire to do good;' core principle of client advocacy