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AAPC CPB CERTIFIED PROFESSIONAL BILLER
EXAM LATEST WITH ACTUAL QUESTIONS AND
CORRECT VERIFIED ANSWERS/ALREADY
GRADED A+
Abuse - .....ANSWER ...✔✔ Actions inconsistent with
accepted, sound medical business or fiscal practice
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.
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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
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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.
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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.
Ambulatory Surgical Center (ASC) - .....ANSWER
...✔✔ State Licensed Medicare-certified supplier (not
provider) of surgical healthcare services that must
accept assignment on Medicare Claims.
AAPC CPB CERTIFIED PROFESSIONAL BILLER
EXAM LATEST WITH ACTUAL QUESTIONS AND
CORRECT VERIFIED ANSWERS/ALREADY
GRADED A+
Abuse - .....ANSWER ...✔✔ Actions inconsistent with
accepted, sound medical business or fiscal practice
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.
,2|Page
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
,3|Page
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.
, 4|Page
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.
Ambulatory Surgical Center (ASC) - .....ANSWER
...✔✔ State Licensed Medicare-certified supplier (not
provider) of surgical healthcare services that must
accept assignment on Medicare Claims.
