CPB Certified Professional Biller
Certification UPDATED ACTUAL Exam
Questions and CORRECT Answers
Abuse - CORRECT ANSWER✔✔- Actions inconsistent with accepted, sound medical
business or fiscal practice
Accept Assignment - CORRECT 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 - CORRECT ANSWER✔✔- The amount owed to a business for
services or goods provided.
Accounts Receivable Aging Report - CORRECT ANSWER✔✔- Shows the status (by date)
of outstanding claims from each payer, as well as payments due from patients.
Accounts Receivable Management - CORRECT ANSWER✔✔- Assists Providers in the
collection of appropriate reimbursement for services rendered; include functions such as
insurance verification/eligibility and preauthorization of services.
Accreditation - CORRECT 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 - CORRECT ANSWER✔✔- Judicial dispuite resolution process in which an
appeals board makes a final determination.
Adjusted Claim - CORRECT ANSWER✔✔- payment correction resulting in additional
payment(s) to the provider.
Advance Beneficiary Notice (ABN) - CORRECT ANSWER✔✔- Document that
acknowledges patient responsiblity for payment if Medicare denies the cliam.
,Adverse Effect - CORRECT 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 - CORRECT 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 - CORRECT ANSWER✔✔- Covering members who are sicker then the
general population.
Allowable Charge - CORRECT ANSWER✔✔- see limiting charge; maximum fee a
physician may charge.
Allowed Charge - CORRECT 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) - CORRECT 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) - CORRECT 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 - CORRECT ANSWER✔✔- Payment system for ambulance
services provided to Medicare Beneficiaries.
, Ambulatory Payment Classification (APC) - CORRECT ANSWER✔✔- Prospective payment
system used to calculate reimbursement for outpatient care according to similar clinical
characteristics and in terms of resources required.
Ambulatory Surgical Center (ASC) - CORRECT ANSWER✔✔- State Licensed Medicare-
certified supplier (not provider) of surgical healthcare services that must accept assignment
on Medicare Claims.
Ambulatory Surgical Center Payment Rate - CORRECT ANSWER✔✔- Predetermined
amount for which ASC services are reimbursed, at 80 percent after adjument for regional
wage variations.
Amendment to the HMO Act of 1973 - CORRECT ANSWER✔✔- Legislation that allowed
federally qualified HMOs to permit members to occasionally use non HMO physicians and
be partially reimbursed.
American Academy of Processional Coders (AAPC) - CORRECT ANSWER✔✔-
Professional 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) - CORRECT ANSWER✔✔- Enables
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 - CORRECT ANSWER✔✔- Claims validation table (as in ANSI ASC X12 837)
AAMA - CORRECT ANSWER✔✔- American Association of Medical Assistants
ABN - CORRECT ANSWER✔✔- Advance Beneficiary Notice
ADA - CORRECT ANSWER✔✔- Americans with Disabilties Act
Certification UPDATED ACTUAL Exam
Questions and CORRECT Answers
Abuse - CORRECT ANSWER✔✔- Actions inconsistent with accepted, sound medical
business or fiscal practice
Accept Assignment - CORRECT 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 - CORRECT ANSWER✔✔- The amount owed to a business for
services or goods provided.
Accounts Receivable Aging Report - CORRECT ANSWER✔✔- Shows the status (by date)
of outstanding claims from each payer, as well as payments due from patients.
Accounts Receivable Management - CORRECT ANSWER✔✔- Assists Providers in the
collection of appropriate reimbursement for services rendered; include functions such as
insurance verification/eligibility and preauthorization of services.
Accreditation - CORRECT 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 - CORRECT ANSWER✔✔- Judicial dispuite resolution process in which an
appeals board makes a final determination.
Adjusted Claim - CORRECT ANSWER✔✔- payment correction resulting in additional
payment(s) to the provider.
Advance Beneficiary Notice (ABN) - CORRECT ANSWER✔✔- Document that
acknowledges patient responsiblity for payment if Medicare denies the cliam.
,Adverse Effect - CORRECT 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 - CORRECT 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 - CORRECT ANSWER✔✔- Covering members who are sicker then the
general population.
Allowable Charge - CORRECT ANSWER✔✔- see limiting charge; maximum fee a
physician may charge.
Allowed Charge - CORRECT 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) - CORRECT 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) - CORRECT 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 - CORRECT ANSWER✔✔- Payment system for ambulance
services provided to Medicare Beneficiaries.
, Ambulatory Payment Classification (APC) - CORRECT ANSWER✔✔- Prospective payment
system used to calculate reimbursement for outpatient care according to similar clinical
characteristics and in terms of resources required.
Ambulatory Surgical Center (ASC) - CORRECT ANSWER✔✔- State Licensed Medicare-
certified supplier (not provider) of surgical healthcare services that must accept assignment
on Medicare Claims.
Ambulatory Surgical Center Payment Rate - CORRECT ANSWER✔✔- Predetermined
amount for which ASC services are reimbursed, at 80 percent after adjument for regional
wage variations.
Amendment to the HMO Act of 1973 - CORRECT ANSWER✔✔- Legislation that allowed
federally qualified HMOs to permit members to occasionally use non HMO physicians and
be partially reimbursed.
American Academy of Processional Coders (AAPC) - CORRECT ANSWER✔✔-
Professional 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) - CORRECT ANSWER✔✔- Enables
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 - CORRECT ANSWER✔✔- Claims validation table (as in ANSI ASC X12 837)
AAMA - CORRECT ANSWER✔✔- American Association of Medical Assistants
ABN - CORRECT ANSWER✔✔- Advance Beneficiary Notice
ADA - CORRECT ANSWER✔✔- Americans with Disabilties Act
