CPB Certified Professional Biller
Certification Questions and Answers
A person who performs services for another under an expressed or implied agreement
is called a(n): - ANSWER-Independent Contractor
a- an- - ANSWER-no,not
AAMA - ANSWER-American Association of Medical Assistants
ab- - ANSWER-away from
abdomin- - ANSWER-abdomen
ABN - ANSWER-Advance Beneficiary Notice
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.
acr- - ANSWER-extremities, top
ad- - ANSWER-toward
ADA - ANSWER-Americans with Disabilties Act
adip- - ANSWER-fat
, 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.
AHA - ANSWER-American Hospital Association
AHFS - ANSWER-American Hospital Formulary Service
AHIMA - ANSWER-American Health Information Management Association
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.
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.
AMA - ANSWER-American Medical Association
Certification Questions and Answers
A person who performs services for another under an expressed or implied agreement
is called a(n): - ANSWER-Independent Contractor
a- an- - ANSWER-no,not
AAMA - ANSWER-American Association of Medical Assistants
ab- - ANSWER-away from
abdomin- - ANSWER-abdomen
ABN - ANSWER-Advance Beneficiary Notice
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.
acr- - ANSWER-extremities, top
ad- - ANSWER-toward
ADA - ANSWER-Americans with Disabilties Act
adip- - ANSWER-fat
, 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.
AHA - ANSWER-American Hospital Association
AHFS - ANSWER-American Hospital Formulary Service
AHIMA - ANSWER-American Health Information Management Association
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.
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.
AMA - ANSWER-American Medical Association
