CPB (Certified Professional Biller) Certification Practice Exam

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What does the term APC stand for in the healthcare billing context?

  1. All Patient Diagnosis-Related Group

  2. Ambulatory Payment Classification

  3. All Patient Refined Diagnosis-Related Group

  4. Ambulance Fee Schedule

The correct answer is: Ambulatory Payment Classification

In the context of healthcare billing, the term APC stands for Ambulatory Payment Classification. This classification system is used to determine how outpatient services are reimbursed under Medicare. Each APC is assigned a specific payment amount that reflects the average cost of providing a particular type of outpatient service. The significance of APCs lies in their role in streamlining payments for outpatient procedures and facilitating the billing and reimbursement process for healthcare providers. This system allows for the categorization of services into groups based on clinical and resource similarities, which helps in managing costs and ensuring providers are compensated appropriately for the services they render. Understanding the intricacies of APCs is essential for billers, as it plays a crucial role in coding and billing outpatient services accurately. By using this system, healthcare facilities can enhance operational efficiency and optimize reimbursement workflows.

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