CCA Exam Prep 2025 Questions With All
Correct & Verified Answers
PPS Correct answer-Prospective Payment System
What is prospective payment system? Correct answer-Payment for all care delivered during an
episode of care based on pre-determined fixed amount (DRGs). Influenced by care setting.
What are the 4 types of Prospective Payment Systems? Correct answer-Capitation, global payment
method, case-rate methodology, and bundled payment.
Capitation Correct answer-System of payment used by managed care plans in which physicians and
hospitals are paid a fixed, 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)
Global Payment Method Correct answer-Third-party payer makes one combined payment to cover
the services of multiple providers who are treating a single episode of care.
Case-Rate Method Correct answer-Reimburses provider for all services provided during entire
encounter or visit, regardless of length of stay. Based on typical costs of condition, and is usually used
in inpatient admissions.
Bundled Payment Correct answer-Reimbursement methodology where a predetermined payment
amount is provided for all services required for a single predefined episode-of-care.
Retrospective payment system Correct answer-Type of fee-for-service reimbursement in which
providers receive recompense after health services have been rendered
fee-for-service Correct answer-a system under which doctors and hospitals receive a payment for
each service they provide
Risk-adjusted payment Correct answer-introduced under ACA, shifts burden of risk for treating
high-risk patients to be shared by all insurers. Meant to make premiums the same.
ACA Correct answer-Affordable Care Act
Risk score Correct answer-indicates how costly an individual may be relative to the average
beneficiary
CMS-HCC Correct answer-Centers for Medicare & Medicaid Services-Hierarchical Condition
Category
CMS-HCC payment Correct answer-uses patient demographic and medical info to predict cost
HCC Correct answer-Hierarchical Condition Categories
Hierarchical Condition Categories Correct answer-Since 2004, HCCs have been used by the Centers
for Medicare and Medicaid Services (CMS) as part of a risk-adjustment model that identifies
individuals with serious acute or chronic conditions.
, CMS Correct answer-Centers for Medicare and Medicaid Services
What are the current valid code sets? Correct answer-ICD-10 CM and PCS, CPT, HCPCS, and NDC
!CD-10-CM is maintained by Correct answer-NCHSq
NCHS Correct answer-National Center for Health Statistics
ICD-10-PCS is maintained by Correct answer-CMS
CMS Correct answer-Centers for Medicare and Medicaid Services
Official coding guidelines are promulgated by the following 4 parties Correct answer-AHA, AHIMA,
NCHS, and CMS.
AHA Correct answer-American Hospital Association
AHIMA Correct answer-American Health Information Management Association
who maintains CPT Correct answer-American Medical Association (AMA)
What are HCPCS Level 1 codes? Correct answer-CPT codes
What are HCPCS Level II codes used for? Correct answer-They were established to report services,
supplies, and procedures not represented in CPT.
PDPM Correct answer-patient driven payment model
What is PDPM and where is it used? Correct answer-Patient driven payment model is used in
SNF(skilled nursing facilities) and uses case-mix variables. It focuses more on the patient.
Minimum Data Set (MDS) Correct answer-a report that focuses on the degree of assistance or
skilled care that each resident of a long-term care facility needs, required reporting
PDGM Correct answer-patient driven groupings model
What is PDGM and where is it used? Correct answer-Patient Driven Groupings Model is used in
HHAs(Home Health Agencies) and utilizes case-mix groupings and patient driven models similar to
PDPM.
Payment unit for PDGM is how many days Correct answer-30, but days to recertify is 60.
APC Correct answer-Ambulatory Payment Classification
RBRVS Correct answer-Resource Based Relative Value Scale
RVU Correct answer-Relative Value Unit
What are the two types of outpatient PPS? Correct answer-OPPS and ASC(Ambulatory Service
Center, outside of the hospital)
Correct & Verified Answers
PPS Correct answer-Prospective Payment System
What is prospective payment system? Correct answer-Payment for all care delivered during an
episode of care based on pre-determined fixed amount (DRGs). Influenced by care setting.
What are the 4 types of Prospective Payment Systems? Correct answer-Capitation, global payment
method, case-rate methodology, and bundled payment.
Capitation Correct answer-System of payment used by managed care plans in which physicians and
hospitals are paid a fixed, 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)
Global Payment Method Correct answer-Third-party payer makes one combined payment to cover
the services of multiple providers who are treating a single episode of care.
Case-Rate Method Correct answer-Reimburses provider for all services provided during entire
encounter or visit, regardless of length of stay. Based on typical costs of condition, and is usually used
in inpatient admissions.
Bundled Payment Correct answer-Reimbursement methodology where a predetermined payment
amount is provided for all services required for a single predefined episode-of-care.
Retrospective payment system Correct answer-Type of fee-for-service reimbursement in which
providers receive recompense after health services have been rendered
fee-for-service Correct answer-a system under which doctors and hospitals receive a payment for
each service they provide
Risk-adjusted payment Correct answer-introduced under ACA, shifts burden of risk for treating
high-risk patients to be shared by all insurers. Meant to make premiums the same.
ACA Correct answer-Affordable Care Act
Risk score Correct answer-indicates how costly an individual may be relative to the average
beneficiary
CMS-HCC Correct answer-Centers for Medicare & Medicaid Services-Hierarchical Condition
Category
CMS-HCC payment Correct answer-uses patient demographic and medical info to predict cost
HCC Correct answer-Hierarchical Condition Categories
Hierarchical Condition Categories Correct answer-Since 2004, HCCs have been used by the Centers
for Medicare and Medicaid Services (CMS) as part of a risk-adjustment model that identifies
individuals with serious acute or chronic conditions.
, CMS Correct answer-Centers for Medicare and Medicaid Services
What are the current valid code sets? Correct answer-ICD-10 CM and PCS, CPT, HCPCS, and NDC
!CD-10-CM is maintained by Correct answer-NCHSq
NCHS Correct answer-National Center for Health Statistics
ICD-10-PCS is maintained by Correct answer-CMS
CMS Correct answer-Centers for Medicare and Medicaid Services
Official coding guidelines are promulgated by the following 4 parties Correct answer-AHA, AHIMA,
NCHS, and CMS.
AHA Correct answer-American Hospital Association
AHIMA Correct answer-American Health Information Management Association
who maintains CPT Correct answer-American Medical Association (AMA)
What are HCPCS Level 1 codes? Correct answer-CPT codes
What are HCPCS Level II codes used for? Correct answer-They were established to report services,
supplies, and procedures not represented in CPT.
PDPM Correct answer-patient driven payment model
What is PDPM and where is it used? Correct answer-Patient driven payment model is used in
SNF(skilled nursing facilities) and uses case-mix variables. It focuses more on the patient.
Minimum Data Set (MDS) Correct answer-a report that focuses on the degree of assistance or
skilled care that each resident of a long-term care facility needs, required reporting
PDGM Correct answer-patient driven groupings model
What is PDGM and where is it used? Correct answer-Patient Driven Groupings Model is used in
HHAs(Home Health Agencies) and utilizes case-mix groupings and patient driven models similar to
PDPM.
Payment unit for PDGM is how many days Correct answer-30, but days to recertify is 60.
APC Correct answer-Ambulatory Payment Classification
RBRVS Correct answer-Resource Based Relative Value Scale
RVU Correct answer-Relative Value Unit
What are the two types of outpatient PPS? Correct answer-OPPS and ASC(Ambulatory Service
Center, outside of the hospital)
