CCA Exam Prep Domain 2 with
Complete Solutions
Allowable fee - ANS-Average or maximum amount the third-party payer will reimburse
providers for the service
Block grant - ANS-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 - ANS-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 - ANS-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 - ANS-Episodes of home health that are contiguous and
separated by no more than 6 days
Adjudication - ANS-The determination of the reimbursement payment based upon the
member's insurance benefits
Adverse selection - ANS-Enrollment of excessive proportion of persons with poor health
status in a healthcare plan or healthcare organization
RBRVS - ANS-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 - ANS-Coding or charging one or two middle levels of service codes
exclusively
AHA's Coding Clinic for ICD-10 CM/PCS - ANS-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 - ANS-MS diagnostic-related groups are organized into this
, Clinical Risk Group - ANS-Capitated, prospective payment system that predicts future
healthcare expenditures for populations
Code range - ANS-Applicable set of diagnosis or procedure codes
Coding Compliance plan - ANS-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 - ANS-Related to mental abilities, such as talking, memory, and problem
solving
Coinsurance - ANS-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 - ANS-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 - ANS-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 - ANS-Minimum percentage of inpatients receiving intensive
rehabilitation services for 13 qualifying conditions to be classified as an inpatient
rehabilitation facility
Complication - ANS-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 - ANS-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
AHA Coding Clinic for HCPCS - ANS-Official coding guidance for HCPCS Level II
procedure, service, and supply codes
Ambulatory payment classification - ANS-Hospital outpatient prospective payment
system. The classification is a resource-based reimbursement system
Ambulatory payment classification group - ANS-They are based on HCPCS/CPT codes.
A single visit can result in multiple groups. There are five types of service: significant
Complete Solutions
Allowable fee - ANS-Average or maximum amount the third-party payer will reimburse
providers for the service
Block grant - ANS-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 - ANS-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 - ANS-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 - ANS-Episodes of home health that are contiguous and
separated by no more than 6 days
Adjudication - ANS-The determination of the reimbursement payment based upon the
member's insurance benefits
Adverse selection - ANS-Enrollment of excessive proportion of persons with poor health
status in a healthcare plan or healthcare organization
RBRVS - ANS-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 - ANS-Coding or charging one or two middle levels of service codes
exclusively
AHA's Coding Clinic for ICD-10 CM/PCS - ANS-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 - ANS-MS diagnostic-related groups are organized into this
, Clinical Risk Group - ANS-Capitated, prospective payment system that predicts future
healthcare expenditures for populations
Code range - ANS-Applicable set of diagnosis or procedure codes
Coding Compliance plan - ANS-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 - ANS-Related to mental abilities, such as talking, memory, and problem
solving
Coinsurance - ANS-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 - ANS-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 - ANS-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 - ANS-Minimum percentage of inpatients receiving intensive
rehabilitation services for 13 qualifying conditions to be classified as an inpatient
rehabilitation facility
Complication - ANS-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 - ANS-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
AHA Coding Clinic for HCPCS - ANS-Official coding guidance for HCPCS Level II
procedure, service, and supply codes
Ambulatory payment classification - ANS-Hospital outpatient prospective payment
system. The classification is a resource-based reimbursement system
Ambulatory payment classification group - ANS-They are based on HCPCS/CPT codes.
A single visit can result in multiple groups. There are five types of service: significant
