CPB Certified Professional Biller Certification Questions & Answers
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Course
CPB Certified Professional Biller
Institution
CPB Certified Professional Biller
Abuse - ANSWERSActions inconsistent with accepted, sound medical business or fiscal practice
Accept Assignment - ANSWERSProvider accepts as payment in full whatever is paid on the cliam by the payer (except for any copayment and or coinsurance amounts.)
Accounts Receivable - ANSWERSThe amount...
CPB Certified Professional Biller
Certification Questions & Answers
Abuse - ANSWERSActions inconsistent with accepted, sound medical business or fiscal
practice
Accept Assignment - ANSWERSProvider accepts as payment in full whatever is paid on
the cliam by the payer (except for any copayment and or coinsurance amounts.)
Accounts Receivable - ANSWERSThe amount owed to a business for services or
goods provided.
Accounts Receivable Aging Report - ANSWERSShows the status (by date) of
outstanding claims from each payer, as well as payments due from patients.
Accounts Receivable Management - ANSWERSAssists Providers in the collection of
appropriate reimbursement for services rendered; include functions such as insurance
verification/eligibility and preauthorization of services.
Accreditation - ANSWERSVoluntary 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 - ANSWERSJudicial dispuite resolution process in which an appeals board
makes a final determination.
Adjusted Claim - ANSWERSpayment correction resulting in additional payment(s) to the
provider.
Advance Beneficiary Notice (ABN) - ANSWERSDocument that acknowledges patient
responsiblity for payment if Medicare denies the cliam.
Adverse Effect - ANSWERSAlso called adverse reaction; the appearance of a
pathologic condition due to ingestion r exposure to a chemical substance properly
administered or taken.
Adverse Reaction - ANSWERSAlso called adverse effect; the appearance of a
pathologic condition due to ingestion r exposure to a chemical substance properly
administered or taken.
Adverse Selection - ANSWERSCovering members who are sicker then the general
population.
, Allowable Charge - ANSWERSsee limiting charge; maximum fee a physician may
charge.
Allowed Charge - ANSWERSThe Maximum amount the payer will reimburse for each
procedure or service, according to the patients policy.
All Patient Diagnosis-Related Group (AP-DRG) - ANSWERSDRG 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) - ANSWERSAdopted 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 - ANSWERSPayment system for ambulance services
provided to Medicare Beneficiaries.
Ambulatory Payment Classification (APC) - ANSWERSProspective payment system
used to calculate reimbursement for outpatient care according to similar clinical
characteristics and in terms of resources required.
Ambulatory Surgical Center (ASC) - ANSWERSState Licensed Medicare-certified
supplier (not provider) of surgical healthcare services that must accept assignment on
Medicare Claims.
Ambulatory Surgical Center Payment Rate - ANSWERSPredetermined amount for
which ASC services are reimbursed, at 80 percent after adjument for regional wage
variations.
Amendment to the HMO Act of 1973 - ANSWERSLegislation that allowed federally
qualified HMOs to permit members to occasionally use non HMO physicians and be
partially reimbursed.
American Academy of Processional Coders (AAPC) - ANSWERSProfessional
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) - ANSWERSEnables medical
assisting professionals to enhance and demonstrate the knowledge, skills, and
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