CPB CERTIFIED PROFESSIONAL
BILLER CERTIFICATION QUESTIONS
& ANSWERS
Abuse - ANSWERActions inconsistent with accepted, sound medical business or fiscal
practice
Accept Assignment - ANSWERProvider accepts as payment in full whatever is paid on
the cliam by the payer (except for any copayment and or coinsurance amounts.)
Accounts Receivable - ANSWERThe amount owed to a business for services or goods
provided.
Accounts Receivable Aging Report - ANSWERShows the status (by date) of
outstanding claims from each payer, as well as payments due from patients.
Accounts Receivable Management - ANSWERAssists Providers in the collection of
appropriate reimbursement for services rendered; include functions such as insurance
verification/eligibility and preauthorization of services.
Accreditation - ANSWERVoluntary 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 - ANSWERJudicial dispuite resolution process in which an appeals board
makes a final determination.
Adjusted Claim - ANSWERpayment correction resulting in additional payment(s) to the
provider.
Advance Beneficiary Notice (ABN) - ANSWERDocument that acknowledges patient
responsiblity for payment if Medicare denies the cliam.
Adverse Effect - ANSWERAlso called adverse reaction; the appearance of a pathologic
condition due to ingestion r exposure to a chemical substance properly administered or
taken.
Adverse Reaction - ANSWERAlso called adverse effect; the appearance of a pathologic
condition due to ingestion r exposure to a chemical substance properly administered or
taken.
Adverse Selection - ANSWERCovering members who are sicker then the general
population.
, Allowable Charge - ANSWERsee limiting charge; maximum fee a physician may
charge.
Allowed Charge - ANSWERThe Maximum amount the payer will reimburse for each
procedure or service, according to the patients policy.
All Patient Diagnosis-Related Group (AP-DRG) - ANSWERDRG 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) - ANSWERAdopted 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 - ANSWERPayment system for ambulance services provided
to Medicare Beneficiaries.
Ambulatory Payment Classification (APC) - ANSWERProspective payment system used
to calculate reimbursement for outpatient care according to similar clinical
characteristics and in terms of resources required.
Ambulatory Surgical Center (ASC) - ANSWERState Licensed Medicare-certified
supplier (not provider) of surgical healthcare services that must accept assignment on
Medicare Claims.
Ambulatory Surgical Center Payment Rate - ANSWERPredetermined amount for which
ASC services are reimbursed, at 80 percent after adjument for regional wage variations.
Amendment to the HMO Act of 1973 - ANSWERLegislation that allowed federally
qualified HMOs to permit members to occasionally use non HMO physicians and be
partially reimbursed.
American Academy of Processional Coders (AAPC) - ANSWERProfessional
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) - ANSWEREnables medical
assisting professionals to enhance and demonstrate the knowledge, skills, and
BILLER CERTIFICATION QUESTIONS
& ANSWERS
Abuse - ANSWERActions inconsistent with accepted, sound medical business or fiscal
practice
Accept Assignment - ANSWERProvider accepts as payment in full whatever is paid on
the cliam by the payer (except for any copayment and or coinsurance amounts.)
Accounts Receivable - ANSWERThe amount owed to a business for services or goods
provided.
Accounts Receivable Aging Report - ANSWERShows the status (by date) of
outstanding claims from each payer, as well as payments due from patients.
Accounts Receivable Management - ANSWERAssists Providers in the collection of
appropriate reimbursement for services rendered; include functions such as insurance
verification/eligibility and preauthorization of services.
Accreditation - ANSWERVoluntary 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 - ANSWERJudicial dispuite resolution process in which an appeals board
makes a final determination.
Adjusted Claim - ANSWERpayment correction resulting in additional payment(s) to the
provider.
Advance Beneficiary Notice (ABN) - ANSWERDocument that acknowledges patient
responsiblity for payment if Medicare denies the cliam.
Adverse Effect - ANSWERAlso called adverse reaction; the appearance of a pathologic
condition due to ingestion r exposure to a chemical substance properly administered or
taken.
Adverse Reaction - ANSWERAlso called adverse effect; the appearance of a pathologic
condition due to ingestion r exposure to a chemical substance properly administered or
taken.
Adverse Selection - ANSWERCovering members who are sicker then the general
population.
, Allowable Charge - ANSWERsee limiting charge; maximum fee a physician may
charge.
Allowed Charge - ANSWERThe Maximum amount the payer will reimburse for each
procedure or service, according to the patients policy.
All Patient Diagnosis-Related Group (AP-DRG) - ANSWERDRG 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) - ANSWERAdopted 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 - ANSWERPayment system for ambulance services provided
to Medicare Beneficiaries.
Ambulatory Payment Classification (APC) - ANSWERProspective payment system used
to calculate reimbursement for outpatient care according to similar clinical
characteristics and in terms of resources required.
Ambulatory Surgical Center (ASC) - ANSWERState Licensed Medicare-certified
supplier (not provider) of surgical healthcare services that must accept assignment on
Medicare Claims.
Ambulatory Surgical Center Payment Rate - ANSWERPredetermined amount for which
ASC services are reimbursed, at 80 percent after adjument for regional wage variations.
Amendment to the HMO Act of 1973 - ANSWERLegislation that allowed federally
qualified HMOs to permit members to occasionally use non HMO physicians and be
partially reimbursed.
American Academy of Processional Coders (AAPC) - ANSWERProfessional
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) - ANSWEREnables medical
assisting professionals to enhance and demonstrate the knowledge, skills, and
