CPB Certified Professional Biller
Certification
Abuse Ans- Actions inconsistent with accepted, sound medical business or fiscal practice
Accept Assignment Ans- 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 Ans- The amount owed to a business for services or goods provided.
Accounts Receivable Aging Report Ans- Shows the status (by date) of outstanding claims from each
payer, as well as payments due from patients.
Accounts Receivable Management Ans- Assists Providers in the collection of appropriate reimbursement
for services rendered; include functions such as insurance verification/eligibility and preauthorization of
services.
Accreditation Ans- 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 Ans- Judicial dispuite resolution process in which an appeals board makes a final
determination.
Adjusted Claim Ans- payment correction resulting in additional payment(s) to the provider.
Advance Beneficiary Notice (ABN) Ans- Document that acknowledges patient responsiblity for payment
if Medicare denies the cliam.
Adverse Effect Ans- 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 Ans- 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 Ans- Covering members who are sicker then the general population.
Allowable Charge Ans- see limiting charge; maximum fee a physician may charge.
Allowed Charge Ans- The Maximum amount the payer will reimburse for each procedure or service,
according to the patients policy.
All Patient Diagnosis-Related Group (AP-DRG) Ans- 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) Ans- 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 Ans- Payment system for ambulance services provided to Medicare
Beneficiaries.
Ambulatory Payment Classification (APC) Ans- 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) Ans- State Licensed Medicare-certified supplier (not provider) of
surgical healthcare services that must accept assignment on Medicare Claims.
Ambulatory Surgical Center Payment Rate Ans- Predetermined amount for which ASC services are
reimbursed, at 80 percent after adjument for regional wage variations.
, Amendment to the HMO Act of 1973 Ans- 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) Ans- 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) Ans- 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 Ans- Claims validation table (as in ANSI ASC X12 837)
AAMA Ans- American Association of Medical Assistants
ABN Ans- Advance Beneficiary Notice
ADA Ans- Americans with Disabilties Act
AHA Ans- American Hospital Association
AHFS Ans- American Hospital Formulary Service
AHIMA Ans- American Health Information Management Association
AMA Ans- American Medical Association
ANSI Ans- American National Standards Institute
APC Ans- Ambulatory Payment Classification
Certification
Abuse Ans- Actions inconsistent with accepted, sound medical business or fiscal practice
Accept Assignment Ans- 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 Ans- The amount owed to a business for services or goods provided.
Accounts Receivable Aging Report Ans- Shows the status (by date) of outstanding claims from each
payer, as well as payments due from patients.
Accounts Receivable Management Ans- Assists Providers in the collection of appropriate reimbursement
for services rendered; include functions such as insurance verification/eligibility and preauthorization of
services.
Accreditation Ans- 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 Ans- Judicial dispuite resolution process in which an appeals board makes a final
determination.
Adjusted Claim Ans- payment correction resulting in additional payment(s) to the provider.
Advance Beneficiary Notice (ABN) Ans- Document that acknowledges patient responsiblity for payment
if Medicare denies the cliam.
Adverse Effect Ans- 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 Ans- 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 Ans- Covering members who are sicker then the general population.
Allowable Charge Ans- see limiting charge; maximum fee a physician may charge.
Allowed Charge Ans- The Maximum amount the payer will reimburse for each procedure or service,
according to the patients policy.
All Patient Diagnosis-Related Group (AP-DRG) Ans- 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) Ans- 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 Ans- Payment system for ambulance services provided to Medicare
Beneficiaries.
Ambulatory Payment Classification (APC) Ans- 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) Ans- State Licensed Medicare-certified supplier (not provider) of
surgical healthcare services that must accept assignment on Medicare Claims.
Ambulatory Surgical Center Payment Rate Ans- Predetermined amount for which ASC services are
reimbursed, at 80 percent after adjument for regional wage variations.
, Amendment to the HMO Act of 1973 Ans- 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) Ans- 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) Ans- 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 Ans- Claims validation table (as in ANSI ASC X12 837)
AAMA Ans- American Association of Medical Assistants
ABN Ans- Advance Beneficiary Notice
ADA Ans- Americans with Disabilties Act
AHA Ans- American Hospital Association
AHFS Ans- American Hospital Formulary Service
AHIMA Ans- American Health Information Management Association
AMA Ans- American Medical Association
ANSI Ans- American National Standards Institute
APC Ans- Ambulatory Payment Classification
