CCA Flashcards Domain 2 Reimbursement
MethodolgiesACTUAL QUESTIONS AND
CORRECT ANSWERS
Ambulatory patient classifications (APC) - CORRECT ANSWERS a prospective payment
system for hospital outpatient services provided to Medicare and Medicaid beneficiaries
Advance Beneficiary Notice (ABN) - CORRECT ANSWERS Written notification to the
patient that Medicare may not or will not cover the cost of a procedure or treatment
Accept assignment - CORRECT ANSWERS This is an agreement that the reimbursement
will be paid directly to the provider, rather than the beneficiary
AP-DRG - CORRECT ANSWERS All Patient Diagnosis-Related Group
Capitation - CORRECT ANSWERS A monthly predetermined amount paid to a primary
care provider, which includes a specific list of services, for each patient-member of a managed
care organization that identifies the physician as their primary care provider, whether the patient
is treated or not.
Case Mix Index (CMI) - CORRECT ANSWERS The average relative weight of all
patients treated at a specific facility, or by a specific physician, to measure clinical severity or
resource utilization
Centers for Medicare and Medicaid Services (CMS) - CORRECT ANSWERS The agency
under the department of health and human services (DHHS) in charge of regulating and
controlling services for those covered by Medicare and Medicaid; developing HCPCS and
updates to the HCPCS Level II code set.
, Case mix index - CORRECT ANSWERS Describing a patient population determined by
specific characteristics, such as third party payer, diagnosis, or age
APR-DRG - CORRECT ANSWERS All Patient Refined Diagnosis-Related Group
CMS - CORRECT ANSWERS Centers for Medicare and Medicaid Services
CMS-1491 - CORRECT ANSWERS Paper claim form used to request reimbursement for
ambulance services
CMS-1500 - CORRECT ANSWERS Paper claim form used by physicians and outpatient
providers to request reimbursement
Deductible - CORRECT ANSWERS An amount the patient must pay out of pocket,
annually, before benefits will be implemented
Do-Insurance - CORRECT ANSWERS An amount paid by the individual based on a
percentage of the total allowed amount for the encounter, service, or treatment
Complications and co-morbidities (CC) - CORRECT ANSWERS unexpected conditions
that develop as a result of a service or hospital stay; certain conditions may or may not affect the
choice of the appropriate DRG
Co-payment - CORRECT ANSWERS A fixed amount the patient must pay out of pocket
for each encounter
Diagnosis related groups (DRG) - CORRECT ANSWERS
MethodolgiesACTUAL QUESTIONS AND
CORRECT ANSWERS
Ambulatory patient classifications (APC) - CORRECT ANSWERS a prospective payment
system for hospital outpatient services provided to Medicare and Medicaid beneficiaries
Advance Beneficiary Notice (ABN) - CORRECT ANSWERS Written notification to the
patient that Medicare may not or will not cover the cost of a procedure or treatment
Accept assignment - CORRECT ANSWERS This is an agreement that the reimbursement
will be paid directly to the provider, rather than the beneficiary
AP-DRG - CORRECT ANSWERS All Patient Diagnosis-Related Group
Capitation - CORRECT ANSWERS A monthly predetermined amount paid to a primary
care provider, which includes a specific list of services, for each patient-member of a managed
care organization that identifies the physician as their primary care provider, whether the patient
is treated or not.
Case Mix Index (CMI) - CORRECT ANSWERS The average relative weight of all
patients treated at a specific facility, or by a specific physician, to measure clinical severity or
resource utilization
Centers for Medicare and Medicaid Services (CMS) - CORRECT ANSWERS The agency
under the department of health and human services (DHHS) in charge of regulating and
controlling services for those covered by Medicare and Medicaid; developing HCPCS and
updates to the HCPCS Level II code set.
, Case mix index - CORRECT ANSWERS Describing a patient population determined by
specific characteristics, such as third party payer, diagnosis, or age
APR-DRG - CORRECT ANSWERS All Patient Refined Diagnosis-Related Group
CMS - CORRECT ANSWERS Centers for Medicare and Medicaid Services
CMS-1491 - CORRECT ANSWERS Paper claim form used to request reimbursement for
ambulance services
CMS-1500 - CORRECT ANSWERS Paper claim form used by physicians and outpatient
providers to request reimbursement
Deductible - CORRECT ANSWERS An amount the patient must pay out of pocket,
annually, before benefits will be implemented
Do-Insurance - CORRECT ANSWERS An amount paid by the individual based on a
percentage of the total allowed amount for the encounter, service, or treatment
Complications and co-morbidities (CC) - CORRECT ANSWERS unexpected conditions
that develop as a result of a service or hospital stay; certain conditions may or may not affect the
choice of the appropriate DRG
Co-payment - CORRECT ANSWERS A fixed amount the patient must pay out of pocket
for each encounter
Diagnosis related groups (DRG) - CORRECT ANSWERS
