CPB (Certified Professional Biller) Certification Practice Exam

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Which term does HIPPS stand for within the healthcare sector?

  1. Health personnel shortage area

  2. Health Maintenance Organization

  3. Health insurance prospective payment system (code set)

  4. Health Plan Employer Data and Information Set

The correct answer is: Health insurance prospective payment system (code set)

The term HIPPS stands for "Health Insurance Prospective Payment System (code set)." This term is particularly relevant in the context of Medicare and Medicaid payment systems, where it relates to categorizing patient data to determine the payment levels for healthcare providers. The HIPPS code set is specifically used to capture information regarding the services delivered and the patient’s condition, allowing for prospective payment that reflects the expected cost of care based on those codes. This coding system is crucial for billing and reimbursement processes within the healthcare industry, supporting accurate and fair compensation for healthcare services rendered.

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