©THESTAR 2025 ALL RIGHTS RESERVED
CCA Exam Prep Domain 2 Study Guide
100% Verified.
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
, ©THESTAR 2025 ALL RIGHTS RESERVED
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
CCA Exam Prep Domain 2 Study Guide
100% Verified.
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
, ©THESTAR 2025 ALL RIGHTS RESERVED
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
