AAPC Certified Professional Biller (CPB) — Question 5

Allowable Charge

Answer options

• A. The Maximum amount the payer will reimburse for each procedure or service, according to the patients policy.
• B. DRG system adapted for use by thirdparty payers to reimburse hospitals for inpatient care provided to nonMedicare beneficiaries (e.g. Blue Cross Blue Shield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources.
• C. See limiting charge; maximum fee a physician may charge.
• D. Adopted by Medicare in 2008 to reimburse hospitals for inpatient care provided to Medicare beneficiaries; expanded original DRG system (based on intensity of resources) to add two subclasses to each DRG that adjusts Medicare inpatient hospital reimbursement rates for of mortality (ROM) (likelihood of dying); each subclass, in turn, is subdivided into four areas: (1) minor, (2) moderate, (3) major, (4) extreme.

Correct answer: C

Explanation

The correct answer, C, defines the limiting charge as the maximum amount a physician can charge. Option A refers to reimbursement limits set by payers, while option B discusses the DRG system for non-Medicare beneficiaries, and option D describes the extended DRG system for Medicare, none of which pertain directly to the limiting charge.