CERTIFIED PROFESSIONAL PROPERTY
SPECIALIST COMPREHENSIVE EXAM 2026
QUESTIONS AND ANSWERS 100% CORRECT
◉ 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.
SPECIALIST COMPREHENSIVE EXAM 2026
QUESTIONS AND ANSWERS 100% CORRECT
◉ 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.
