CPB (Certified Professional Biller) Certification Practice Exam

What is the connotation of "Adjudication" in medical billing?

1. Assists providers in the collection of appropriate reimbursement

2. Process that a healthcare facility undergoes

3. Judicial dispute resolution process by an appeals board

4. Document that acknowledges patient responsibility for payment

The correct answer is: Judicial dispute resolution process by an appeals board

The term "Adjudication" in medical billing primarily refers to the process by which an insurance company resolves claims submitted by healthcare providers. It involves the review of the claim to determine whether the services rendered are covered under the patient's insurance plan, how much will be reimbursed, and which parties are responsible for payment. The connotation of "adjudication" being a judicial dispute resolution process by an appeals board highlights that if there are disagreements regarding the amounts billed or coverage, an appeals board may examine the case. This aspect underscores the formalized nature of adjudication, reflecting its complexity and the structured processes involved in resolving disputes. In the context of the other possible choices, while they touch on related concepts of reimbursement and payment responsibilities, they don’t accurately define the judicial and dispute-resolution characteristics that are inherent in the adjudication process itself. The selected option captures the essence of adjudication and its role within the healthcare billing framework.