AAPC CPB Certified Professional Biller Certification.pdf file:///C:/Users/HP/Desktop/New%20folder%20(2)/AAPC%20CPB%
AAPC CPB Certified Professional Biller
Certification
1. Abuse: Actions inconsistent with accepted, sound medical business or fiscal
practice
2. Accept Assignment: Provider accepts as payment in full whatever is paid on the
cliam by the payer (except for any copayment and or coinsurance amounts.)
3. Accounts Receivable: The amount owed to a business for services or goods
provided.
4. Accounts Receivable Aging Report: Shows the status (by date) of outstanding
claims from each payer, as well as payments due from patients.
5. Accounts Receivable Management: Assists Providers in the collection of ap-
propriate reimbursement for services rendered; include functions such as insurance
verification/eligibility and preauthorization of services.
6. Accreditation: 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.
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,AAPC CPB Certified Professional Biller Certification.pdf file:///C:/Users/HP/Desktop/New%20folder%20(2)/AAPC%20CPB%
7. Adjudication: Judicial dispuite resolution process in which an appeals board
makes a final determination.
8. Adjusted Claim: payment correction resulting in additional payment(s) to the
provider.
9. Advance Beneficiary Notice (ABN): Document that acknowledges patient re-
sponsiblity for payment if Medicare denies the cliam.
10. Adverse Effect: Also called adverse reaction; the appearance of a pathologic
condition due to ingestion r exposure to a chemical substance properly administered or
taken.
11. Adverse Reaction: Also called adverse effect; the appearance of a pathologic
condition due to ingestion r exposure to a chemical substance properly administered or
taken.
12. Adverse Selection: Covering members who are sicker then the general popu-
lation.
13. Allowable Charge: see limiting charge; maximum fee a physician may charge.
14. Allowed Charge: The Maximum amount the payer will reimburse for each
procedure or service, according to the patients policy.
15. All Patient Diagnosis-Related Group (AP-DRG): DRG system adapted for use
by third-party payers to reimburse hospitals for inpatient care provided to
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,AAPC CPB Certified Professional Biller Certification.pdf file:///C:/Users/HP/Desktop/New%20folder%20(2)/AAPC%20CPB%
non-Medicare beneficiaries (e.g. Blue Cross Blue Shield, commercial health plans,
TRICARE); DRG assignment is based on intensity of resources.
16. All Patient Refined Diagnosis-Related Group (ARP-DRG): 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 reimburse-
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