CCA Exam Prep Domain 2 Questions & Answers.
1. Allowable fee Average or maximum amount the third-party payer will
reimburse
providers for the service
2. Block grant 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
3. Capitated It is a method of payment for health services in which the
payment
third-party payer reimburses providers a fixed, per capita
method
amount for a period. "Per capita" means "per head"
4. Case-based payment Type of prospective payment method in which the third-party
payer
reimburses the provider a fixed, preestablished payment for
each case
5. Adjacent episodes of care Episodes of home health that are contiguous and
separated by no more than 6 days
6. Adjudication The determination of the reimbursement payment based
upon the
member's insurance benefits
7. Adverse selection Enrollment of excessive proportion of persons with poor
health
status in a healthcare plan or healthcare organization
8. RBRVS 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 ditterent settings,
the skill and training levels required to perform the services,
and the time and risk involved
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13
, CCA Exam Prep Domain 2 Questions & Answers.
9. Clustering Coding or charging one or two middle levels of service
codes exclu- sively
10. AHA's Coding Clinic
for ICD-10 CM/PCS
2/
13
1. Allowable fee Average or maximum amount the third-party payer will
reimburse
providers for the service
2. Block grant 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
3. Capitated It is a method of payment for health services in which the
payment
third-party payer reimburses providers a fixed, per capita
method
amount for a period. "Per capita" means "per head"
4. Case-based payment Type of prospective payment method in which the third-party
payer
reimburses the provider a fixed, preestablished payment for
each case
5. Adjacent episodes of care Episodes of home health that are contiguous and
separated by no more than 6 days
6. Adjudication The determination of the reimbursement payment based
upon the
member's insurance benefits
7. Adverse selection Enrollment of excessive proportion of persons with poor
health
status in a healthcare plan or healthcare organization
8. RBRVS 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 ditterent settings,
the skill and training levels required to perform the services,
and the time and risk involved
1/
13
, CCA Exam Prep Domain 2 Questions & Answers.
9. Clustering Coding or charging one or two middle levels of service
codes exclu- sively
10. AHA's Coding Clinic
for ICD-10 CM/PCS
2/
13
