CPB (Certified Professional Biller) Certification Practice Exam

What is the maximum fee a physician may charge referred to as?

1. Allowed Charge

2. All Patient Diagnosis-Related Group

3. Adverse Selection

4. Adverse Reaction

The correct answer is: Allowed Charge

The maximum fee that a physician may charge is referred to as the "Allowed Charge." This term represents the highest amount that a payer (such as an insurance company) agrees to pay for a particular service. It is important because it determines how much the healthcare provider can bill for their services and influences both the patient's out-of-pocket costs and the provider’s overall revenue. The Allowed Charge is crucial for ensuring that there is a standardized approach to billing within the healthcare system, preventing excessive charges from being levied on patients. It also plays a significant role in negotiations between healthcare providers and payers, helping to establish fair compensation for medical services. The other terms listed do not relate to the maximum fee a physician may charge. For example, "All Patient Diagnosis-Related Group" refers to a classification system for inpatient hospital services, while "Adverse Selection" and "Adverse Reaction" pertain to risk management and patient safety concerns, respectively. These concepts are important in their contexts but do not define the maximum fee a physician can charge.