CCA Exam Prep Domain 2 2023

CCA Exam Prep Domain 2 2023 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 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 Continues...