CPB Chapter 9 – Billing Exam Study
Guide with Complete Solutions
Money owed to the practice for services rendered and billed - Answer️️ -
Account Receivables
A review and evaluation of healthcare procedures and documentation for
the purpose of comparing the quality of services provided i...
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
CPB Chapter 9 – Billing Exam Study
Guide with Complete Solutions
Money owed to the practice for services rendered and billed - Answer✔️✔️-
Account Receivables
A review and evaluation of healthcare procedures and documentation for
the purpose of comparing the quality of services provided in a given
situation - Answer✔️✔️-Audit
Under the birthday rule, the health plan of the parent whose birthday
comes first in the calendar year (not including the year) is designated as the
primary plan - Answer✔️✔️-Birthday Rule
A hospital-specific electronic list that includes all hospital procedures,
services, supplies, and drugs that are billed to payers. Synonymous with
charge description master (CDM) - Answer✔️✔️-Chargemaster
A software program that reviews claims for key components before the
claims are presented to an insurance company - Answer✔️✔️-Claim
scrubber
A claim with no errors - Answer✔️✔️-Clean claim
The standard claim form used by non-institutional provider or supplier to
bill claims - Answer✔️✔️-CMS 1500 Form
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
Current Procedural Terminology is a five digit code used to describe
medical, surgical, radiology, laboratory, anesthesiology, and
evaluation/management services of physicians, hospitals, and other
healthcare providers - Answer✔️✔️-CPT
Alphanumeric codes and primarily include non-physician services, such as
ambulance services and prosthetic devices, and represent items and
supplies and non-physician services. - Answer✔️✔️-HCPCS Level II
Describes the process of transferring data electronically between providers
and insurance payers - Answer✔️✔️-Electronic data interchange (EDI)
A list of fees the physician establishes is the fair price for the services they
provide - Answer✔️✔️-Fee schedule
when a contractor or fiscal intermediary makes a ruling as to whether a
service or item can be reimbursed - Answer✔️✔️-Loal Coverage
Determination (LCD)
rulings specify the Medicare coverage of specific services on a national
level - Answer✔️✔️-National Coverage Determination (NCD)
A requirement that a physician obtain approval from a health plan to
receive a specific procedure or prescribe a specific medication -
Answer✔️✔️-Prior authorization
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
When an insurance company attempts to recoup expenses for a paid claim
when another payer should have been responsible - Answer✔️✔️-
Subrogation
Cost based fee schedules are developed by determining - Answer✔️✔️-total
cost of all of the procedures the physician will perform
Cost based fee schedules are developed by accounting for all the costs
involved with providing a procedure or service. What does this include? -
Answer✔️✔️-lease or rental payments; utilities; office supplies and
equipment; loan fees; maintenance fees;
employee labor; malpractice and/or liability insurance; and health
insurance and other benefit costs.
The physician payment schedule is determined by the - Answer✔️✔️-
Insurance payer - The physician payment schedule is set by the payer,
either government (CMS) or private. The payer determines the amount that
will be reimbursed to the physician or qualified healthcare professional for
services or procedures rendered.
Failure to post a contractual adjustment to a patient's account will -
Answer✔️✔️-leave a balance on the patient's account that the patient should
not be responsible for paying. When a provider agrees to accept the
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