3/1/25, 11:38 AM CPB Certified Professional Biller
CPB Certified Professional Biller Certification 2025
CPB CERTIFIED PROFESSIONAL BILLER
CERTIFICATION NEWEST 2025 ACTUAL EXAM
COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS \\VERIFIED ANSWERS
ALREADY GRADED A+ GUARANTEED PASS
Terms in this set (250)
DRG system adapted for use by third-party payers to
All Patient Diagnosis-Related reimburse hospitals for inpatient care provided to
Group (AP- DRG) non-Medicare beneficiaries (e.g. Blue Cross Blue
Shield, commercial health plans, TRICARE); DRG
assignment is based on intensity of resources.
Adopted by Medicare in 2008 to reimburse hospitals
for inpatient care provided to Medicare beneficiaries;
expanded originial DRG system (based on intensity of
All Patient Refined
resources) to add two subclasses to each DRG that
Diagnosis-Related Group
adjusts Medicare inpatient
(ARP-DRG)
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 Payment system for ambulance services provided to Medicare
Beneficiaries.
Prospective payment system used to calculate
Ambulatory Payment
Classification (APC) reimbursement for outpatient care according to
similar clinical characteristics and in terms of
resources required.
State Licensed Medicare-certified supplier (not
Ambulatory Surgical Center
(ASC) provider) of surgical healthcare services that must
1/1
2
, 3/1/25, 11:38 AM CPB Certified Professional Biller
accept assignment on Medicare Claims.
Predetermined amount for which ASC services are
Ambulatory Surgical Center
Payment Rate reimbursed, at 80 percent after adjument for regional
wage variations.
Legislation that allowed federally qualified HMOs to
Amendment to the HMO Act
of 1973 permit members to occasionally use non HMO
physicians and be partially reimbursed.
Professional association established to provide a national
American Academy of certification and
Processional Coders credentialing process, to support the national and local
(AAPC) membership by providing educational products and
opportunities to network, and to increase and promote
national recognition and awareness of professional
coding.
Enables medical assisting professionals to enhance and
American Association of
demonstrate the
Medical Assistants
knowledge, skills, and professionalism required by
(AAMA)
employers and patients; as well as protect medical
assistants' right to practice.
benign not cancerous
billing entity the legal business name of the provider's pratice.
determines coverage by primary and secondary
birthday rule
policies when each parent subscribes to a different
health insurance plan.
black box edits nonpublished code edits, which were discontinued in 2000.
program that allows BCBS subscribers to receive local
BlueCard Program
Blue Plan healthcare benefits while traveling or
living outside of their plan's area.
insurance plan created in 1929 when Baylor University Hospital,
in Dallas, TX,
Blue Cross (BC) approached teachers in Dallas school district with a
plan that guaranteed up to 21 days of hospitalization
per year for subscribers and each dependent for a
$6
annual premium.
joint venture between Blue Cross and Blue Shield
Blue Cross Blue Shield
(BCBS) where the corporation shared one building and
computer
2/1
2
CPB Certified Professional Biller Certification 2025
CPB CERTIFIED PROFESSIONAL BILLER
CERTIFICATION NEWEST 2025 ACTUAL EXAM
COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS \\VERIFIED ANSWERS
ALREADY GRADED A+ GUARANTEED PASS
Terms in this set (250)
DRG system adapted for use by third-party payers to
All Patient Diagnosis-Related reimburse hospitals for inpatient care provided to
Group (AP- DRG) non-Medicare beneficiaries (e.g. Blue Cross Blue
Shield, commercial health plans, TRICARE); DRG
assignment is based on intensity of resources.
Adopted by Medicare in 2008 to reimburse hospitals
for inpatient care provided to Medicare beneficiaries;
expanded originial DRG system (based on intensity of
All Patient Refined
resources) to add two subclasses to each DRG that
Diagnosis-Related Group
adjusts Medicare inpatient
(ARP-DRG)
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 Payment system for ambulance services provided to Medicare
Beneficiaries.
Prospective payment system used to calculate
Ambulatory Payment
Classification (APC) reimbursement for outpatient care according to
similar clinical characteristics and in terms of
resources required.
State Licensed Medicare-certified supplier (not
Ambulatory Surgical Center
(ASC) provider) of surgical healthcare services that must
1/1
2
, 3/1/25, 11:38 AM CPB Certified Professional Biller
accept assignment on Medicare Claims.
Predetermined amount for which ASC services are
Ambulatory Surgical Center
Payment Rate reimbursed, at 80 percent after adjument for regional
wage variations.
Legislation that allowed federally qualified HMOs to
Amendment to the HMO Act
of 1973 permit members to occasionally use non HMO
physicians and be partially reimbursed.
Professional association established to provide a national
American Academy of certification and
Processional Coders credentialing process, to support the national and local
(AAPC) membership by providing educational products and
opportunities to network, and to increase and promote
national recognition and awareness of professional
coding.
Enables medical assisting professionals to enhance and
American Association of
demonstrate the
Medical Assistants
knowledge, skills, and professionalism required by
(AAMA)
employers and patients; as well as protect medical
assistants' right to practice.
benign not cancerous
billing entity the legal business name of the provider's pratice.
determines coverage by primary and secondary
birthday rule
policies when each parent subscribes to a different
health insurance plan.
black box edits nonpublished code edits, which were discontinued in 2000.
program that allows BCBS subscribers to receive local
BlueCard Program
Blue Plan healthcare benefits while traveling or
living outside of their plan's area.
insurance plan created in 1929 when Baylor University Hospital,
in Dallas, TX,
Blue Cross (BC) approached teachers in Dallas school district with a
plan that guaranteed up to 21 days of hospitalization
per year for subscribers and each dependent for a
$6
annual premium.
joint venture between Blue Cross and Blue Shield
Blue Cross Blue Shield
(BCBS) where the corporation shared one building and
computer
2/1
2
