CPB (Certified Professional Biller) Certification Practice Exam

Which entity must accept assignment on Medicare claims to be considered a State Licensed Medicare-certified supplier of surgical healthcare services?

1. Ambulatory Surgical Center Payment Rate

2. Ambulance Fee Schedule

3. Ambulatory Surgical Center

4. Allowed Charge

The correct answer is: Ambulatory Surgical Center

To be recognized as a State Licensed Medicare-certified supplier of surgical healthcare services, the entity must be an Ambulatory Surgical Center (ASC). ASCs are specialized facilities that provide surgical services to patients on an outpatient basis. Acceptance of assignment on Medicare claims is a key requirement for ASCs, as it signifies their agreement to accept the payment rates established by Medicare as full payment for services rendered. This requirement is crucial because it ensures that the facility adheres to the regulations surrounding Medicare reimbursement, promoting compliance and ensuring patients are not billed more than the allowed amounts. In contrast, the other options focus on different aspects of Medicare payments and services. The Ambulatory Surgical Center Payment Rate outlines the reimbursement structure, while the Ambulance Fee Schedule pertains to ambulance services, and Allowed Charge relates to maximum reimbursement levels rather than the entity’s certification and qualification as a surgical healthcare provider. Thus, recognizing the specific qualifications of ASCs in terms of Medicare assignment is vital for understanding their role in the healthcare system.