Exam (elaborations)
CPB Certified Professional Biller Certification
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CPB Certified Professional Biller Certification
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CPB CERTIFIED PROFESSIONALBILLER CERTIFICATION
b Abuse - Actions inconsistent with accepted, sound medical business or fiscal practice
Accept Assignment - Provider accepts as payment in full whatever is paid on the cliam by the payer
(except for any copayment and or coinsurance amounts.)
Accounts Receivable - The amount owed to a business for services or goods provided.
Accounts Receivable Aging Report - Shows the status (by date) of outstanding claims from each payer, as
well as payments due from patients.
Accounts Receivable Management - Assists Providers in the collection of appropriate reimbursement for
services rendered; include functions such as insurance verification/eligibility and preauthorization of
services.
Accreditation - Voluntary Process that a healthcare facility or organization (e.g. hospital or manged care
plan) undergoes to demonstarte that it has met standards beyond those required by law.
Adjudication - Judicial dispuite resolution process in which an appeals board makes a final
determination.
Adjusted Claim - payment correction resulting in additional payment(s) to the provider.
Advance Beneficiary Notice (ABN) - Document that acknowledges patient responsiblity for payment if
Medicare denies the cliam.
Adverse Effect - Also called adverse reaction; the appearance of a pathologic condition due to ingestion r
exposure to a chemical substance properly administered or taken.
Adverse Reaction - Also called adverse effect; the appearance of a pathologic condition due to ingestion r
exposure to a chemical substance properly administered or taken.
Adverse Selection - Covering members who are sicker then the general population.
Allowable Charge - see limiting charge; maximum fee a physician may charge.
Allowed Charge - The Maximum amount the payer will reimburse for each procedure or service,
according to the patients policy.
All Patient Diagnosis-Related Group (AP-DRG) - DRG system adapted for use by third-party payers to
reimburse hospitals for inpatient care provided to non-Medicare beneficiaries (e.g. Blue Cross Blue
Shield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources.
All Patient Refined Diagnosis-Related Group (ARP-DRG) - Adopted by Medicare in 2008 to reimburse
hospitals for inpatient care provided to Medicare beneficiaries; expanded originial DRG system (based on
intensity of resources) to add two subclasses to each DRG that adjusts Medicare inpatient hospital
, reimbursement rates for severity of illness (SOI) (extent of physiological decompensation or organ
system loss of function) and risk of mortality (ROM) (likelihood of dying); each subclass, in turn, is
subdivided into four areas: (1) minor, (2) moderate, (3) major, (4) extreme.
Ambulance Fee Schedule - Payment system for ambulance services provided to Medicare Beneficiaries.
Ambulatory Payment Classification (APC) - Prospective payment system used to calculate reimbursement
for outpatient care according to similar clinical characteristics and in terms of resources required.
Ambulatory Surgical Center (ASC) - State Licensed Medicare-certified supplier (not provider) of surgical
healthcare services that must accept assignment on Medicare Claims.
Ambulatory Surgical Center Payment Rate - Predetermined amount for which ASC services are
reimbursed, at 80 percent after adjument for regional wage variations.
Amendment to the HMO Act of 1973 - Legislation that allowed federally qualified HMOs to permit
members to occasionally use non HMO physicians and be partially reimbursed.
American Academy of Processional Coders (AAPC) - Professional association established to provide a
national certification and credentialing process, to support the national and local membership by
providing educational products and opportunities to network, and to increase and promote national
recognition and awareness of professional coding.
American Association of Medical Assistants (AAMA) - Enables medical assisting professionals to enhance
and demonstrate the knowledge, skills, and professionalism required by employers and patients; as well
as protect medical assistants' right to practice.
837 - Claims validation table (as in ANSI ASC X12 837)
AAMA - American Association of Medical Assistants
ABN - Advance Beneficiary Notice
ADA - Americans with Disabilties Act
AHA - American Hospital Association
AHFS - American Hospital Formulary Service
AHIMA - American Health Information Management Association
AMA - American Medical Association
ANSI - American National Standards Institute
APC - Ambulatory Payment Classification
AP-DRG - All Patient Diagnosis-Related Group
ARP-DRG - All Patient Refined Diagnosis-Related Group
ASC - Accredited Standards Committee
ASC - Ambulatory Surgical Center
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