CCA Exam Prep 2025 – Complete Study Guide
with Key Concepts and Practice Questions
1. PPS Prospective Payment System
2. What is prospec- Payment for all care delivered during an episode of care based on pre-determined
tive payment sys- �xed amount (DRGs). In uenced by care setting.
tem?
3. What are the 4 Capitation, global payment method, case-rate methodology, and bundled pay-
types of Prospec- ment.
tive Payment Sys-
tems?
4. Capitation System of payment used by managed care plans in which physicians and hospitals
are paid a �xed, per capita amount for each patient enrolled over a stated period
regardless of the type and number of services provided; reimbursement to the
hospital on a per-member/per-month basis to cover costs for the members of
the plan. (PMPM)
5. Global Payment Third-party payer makes one combined payment to cover the services of multiple
Method providers who are treating a single episode of care.
6. Case-Rate Reimburses provider for all services provided during entire encounter or visit,
Method regardless of length of stay. Based on typical costs of condition, and is usually
used in inpatient admissions.
7. Bundled Pay- Reimbursement methodology where a predetermined payment amount is pro-
ment vided for all services required for a single prede�ned episode-of-care.
8. Retrospective Type of fee-for-service reimbursement in which providers receive recompense
payment system after health services have been rendered
9. fee-for-service a system under which doctors and hospitals receive a payment for each service
they provide
10.
, Risk-adjusted introduced under ACA, shifts burden of risk for treating high-risk patients to be
payment shared by all insurers. Meant to make premiums the same.
11. ACA A ordable Care Act
12. Risk score indicates how costly an individual may be relative to the average bene�ciary
13. CMS-HCC Centers for Medicare & Medicaid Services-Hierarchical Condition Category
14. CMS-HCC pay- uses patient demographic and medical info to predict cost
ment
15. HCC Hierarchical Condition Categories
16. Hierarchical Con- Since 2004, HCCs have been used by the Centers for Medicare and Medicaid
dition Categories Services (CMS) as part of a risk-adjustment model that identi�es individuals with
serious acute or chronic conditions.
17. CMS Centers for Medicare and Medicaid Services
18. What are the cur- ICD-10 CM and PCS, CPT, HCPCS, and NDC
rent valid code
sets?
19. !CD-10-CM is NCHSq
maintained by
20. NCHS National Center for Health Statistics
21. ICD-10-PCS is CMS
maintained by
22. O�cial coding AHA, AHIMA, NCHS, and CMS.
guidelines are
promulgated by
with Key Concepts and Practice Questions
1. PPS Prospective Payment System
2. What is prospec- Payment for all care delivered during an episode of care based on pre-determined
tive payment sys- �xed amount (DRGs). In uenced by care setting.
tem?
3. What are the 4 Capitation, global payment method, case-rate methodology, and bundled pay-
types of Prospec- ment.
tive Payment Sys-
tems?
4. Capitation System of payment used by managed care plans in which physicians and hospitals
are paid a �xed, per capita amount for each patient enrolled over a stated period
regardless of the type and number of services provided; reimbursement to the
hospital on a per-member/per-month basis to cover costs for the members of
the plan. (PMPM)
5. Global Payment Third-party payer makes one combined payment to cover the services of multiple
Method providers who are treating a single episode of care.
6. Case-Rate Reimburses provider for all services provided during entire encounter or visit,
Method regardless of length of stay. Based on typical costs of condition, and is usually
used in inpatient admissions.
7. Bundled Pay- Reimbursement methodology where a predetermined payment amount is pro-
ment vided for all services required for a single prede�ned episode-of-care.
8. Retrospective Type of fee-for-service reimbursement in which providers receive recompense
payment system after health services have been rendered
9. fee-for-service a system under which doctors and hospitals receive a payment for each service
they provide
10.
, Risk-adjusted introduced under ACA, shifts burden of risk for treating high-risk patients to be
payment shared by all insurers. Meant to make premiums the same.
11. ACA A ordable Care Act
12. Risk score indicates how costly an individual may be relative to the average bene�ciary
13. CMS-HCC Centers for Medicare & Medicaid Services-Hierarchical Condition Category
14. CMS-HCC pay- uses patient demographic and medical info to predict cost
ment
15. HCC Hierarchical Condition Categories
16. Hierarchical Con- Since 2004, HCCs have been used by the Centers for Medicare and Medicaid
dition Categories Services (CMS) as part of a risk-adjustment model that identi�es individuals with
serious acute or chronic conditions.
17. CMS Centers for Medicare and Medicaid Services
18. What are the cur- ICD-10 CM and PCS, CPT, HCPCS, and NDC
rent valid code
sets?
19. !CD-10-CM is NCHSq
maintained by
20. NCHS National Center for Health Statistics
21. ICD-10-PCS is CMS
maintained by
22. O�cial coding AHA, AHIMA, NCHS, and CMS.
guidelines are
promulgated by
