CPB-CERTIFIED PROFESSIONAL BILLER
CERTIFICATION (MEDICAL BILLING CPB
EXAM) EXAM SCORED A+
Abuse Answer - Actions inconsistent with accepted, sound medical business or
fiscal practice
Accept Assignment Answer - 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 Answer - The amount owed to a business for services or
goods provided.
Accounts Receivable Aging Report Answer - Shows the status (by date) of
outstanding claims from each payer, as well as payments due from patients.
Accounts Receivable Management Answer - Assists Providers in the collection
of appropriate reimbursement for services rendered; include functions such as
insurance verification/eligibility and preauthorization of services.
Accreditation Answer - 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 Answer - Judicial dispuite resolution process in which an appeals
board makes a final determination.
,Adjusted Claim Answer - payment correction resulting in additional payment(s)
to the provider.
Advance Beneficiary Notice (ABN) Answer - Document that acknowledges
patient responsiblity for payment if Medicare denies the cliam.
Adverse Effect Answer - 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 Answer - 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 Answer - Covering members who are sicker then the general
population.
Allowable Charge Answer - see limiting charge; maximum fee a physician may
charge.
Allowed Charge Answer - The Maximum amount the payer will reimburse for
each procedure or service, according to the patients policy.
All Patient Diagnosis-Related Group (AP-DRG) Answer - 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) Answer - 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 Answer - Payment system for ambulance services
provided to Medicare Beneficiaries.
Ambulatory Payment Classification (APC) Answer - 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) Answer - State Licensed Medicare-certified
supplier (not provider) of surgical healthcare services that must accept
assignment on Medicare Claims.
Ambulatory Surgical Center Payment Rate Answer - Predetermined amount for
which ASC services are reimbursed, at 80 percent after adjument for regional
wage variations.
Amendment to the HMO Act of 1973 Answer - 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) Answer - Professional
association established to provide a national certification and credentialing
process, to support the national and local membership by providing
CERTIFICATION (MEDICAL BILLING CPB
EXAM) EXAM SCORED A+
Abuse Answer - Actions inconsistent with accepted, sound medical business or
fiscal practice
Accept Assignment Answer - 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 Answer - The amount owed to a business for services or
goods provided.
Accounts Receivable Aging Report Answer - Shows the status (by date) of
outstanding claims from each payer, as well as payments due from patients.
Accounts Receivable Management Answer - Assists Providers in the collection
of appropriate reimbursement for services rendered; include functions such as
insurance verification/eligibility and preauthorization of services.
Accreditation Answer - 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 Answer - Judicial dispuite resolution process in which an appeals
board makes a final determination.
,Adjusted Claim Answer - payment correction resulting in additional payment(s)
to the provider.
Advance Beneficiary Notice (ABN) Answer - Document that acknowledges
patient responsiblity for payment if Medicare denies the cliam.
Adverse Effect Answer - 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 Answer - 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 Answer - Covering members who are sicker then the general
population.
Allowable Charge Answer - see limiting charge; maximum fee a physician may
charge.
Allowed Charge Answer - The Maximum amount the payer will reimburse for
each procedure or service, according to the patients policy.
All Patient Diagnosis-Related Group (AP-DRG) Answer - 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) Answer - 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 Answer - Payment system for ambulance services
provided to Medicare Beneficiaries.
Ambulatory Payment Classification (APC) Answer - 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) Answer - State Licensed Medicare-certified
supplier (not provider) of surgical healthcare services that must accept
assignment on Medicare Claims.
Ambulatory Surgical Center Payment Rate Answer - Predetermined amount for
which ASC services are reimbursed, at 80 percent after adjument for regional
wage variations.
Amendment to the HMO Act of 1973 Answer - 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) Answer - Professional
association established to provide a national certification and credentialing
process, to support the national and local membership by providing
