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 professionalism required by employers and patients; as well as protect medical assistants' right to practice. 837 - ANSWERSClaims validation table (as in ANSI ASC X12 837) AAMA - ANSWERSAmerican Association of Medical Assistants ABN - ANSWERSAdvance Beneficiary Notice ADA - ANSWERSAmericans with Disabilties Act AHA - ANSWERSAmerican Hospital Association AHFS - ANSWERSAmerican Hospital Formulary Service AHIMA - ANSWERSAmerican Health Information Management Association AMA - ANSWERSAmerican Medical Association ANSI - ANSWERSAmerican National Standards Institute APC - ANSWERSAmbulatory Payment Classification AP-DRG - ANSWERSAll Patient Diagnosis-Related Group ARP-DRG - ANSWERSAll Patient Refined Diagnosis-Related Group ASC - ANSWERSAccredited Standards Committee ASC - ANSWERSAmbulatory Surgical Center BC - ANSWERSBlue Cross BCAC - ANSWERSBeneficary Counseling and Assistance Coordinator BCBS - ANSWERSBlue Cross Blue Shield BCBSA - ANSWERSBlue Cross Blue Shield Association BS - ANSWERSBlue Shield BSR - ANSWERSBeneficiary Services Representative CA - ANSWERSCancer or Carcinoma CAC - ANSWERSCommon Access Card