Healthcare Administration FBLA Questions With Complete Solutions

AAPCC - Adjusted Average Per Capita Cost correct answer: The basis for Health Maintenance Organization (HMO) or Competitive Medical Plan (CMP) reimbursement under Medicare-risk contracts. The average monthly amount received per enrollee is currently calculated as 95 percent of the average costs to deliver medical care in the fee-for-service sector. It is the Centers for Medicare & Medicaid Services' (CMS's) best estimate of the amount of money care costs for Medicare recipients under fee-for-service Medicare in a given area. AAPPO correct answer: American Association of Preferred Provider Organizations The leading national association of preferred provider organizations (PPOs) and affiliate organizations, and was established in 1983 to advance awareness of the benefits — greater access, choice and flexibility — that PPOs bring to American health care. Access correct answer: A patient's ability to obtain medical care determined by the availability of medical services, their acceptability to the patient, the location of health care facilities, transportation, hours of operation, and cost of care. Accounts Receivable correct answer: The balance of money owed to a client by others. Accreditation correct answer: The process by which an organization recognizes a program of study or an institution as meeting predetermined standards. Three organizations that accredit managed care plans are the National Committee for Quality Assurance (NCQA), URAC and the Joint Commission. ACF - Ambulatory Care Facility correct answer: A medical care center that provides a wide range of healthcare services, including preventive care, acute care, surgery, and outpatient care, in a centralized facility. Also known as a medical clinic or medical center. Actuary correct answer: A person trained in statistics, accounting and mathematics who conducts statistical studies such as determining insurance policy rates, dividend reserves and dividends, as well as conducts various other statistical studies. Acute Care correct answer: Medical treatment rendered to people whose illnesses or medical problems are short-term or don't require long-term continuing care. Unlike chronic care, acute care is often necessary for only a short time. Adherence correct answer: The ability of a patient to take their medication or follow a treatment protocol according to the directions for which it was prescribed; a patient taking the prescribed dose of medication at the prescribed frequency for the prescribed length of time. Also referred to as compliance. Adjudication correct answer: The process of completing all validity, process, and file edits necessary to prepare a claim for final payment or denial. Adjustment correct answer: A credit or debit amount appearing at the carrier/group level on claims and adminis