CPB Certified Professional Biller Certification Practice Exam

What is the definition of GEM in healthcare billing?

1. General Enrollment Management

2. General Equivalency Mapping

3. Global Evidence Metric

4. Generalized Expense Model

The correct answer is: General Equivalency Mapping

The definition of GEM in healthcare billing refers to General Equivalency Mapping. GEM is a tool used in the transition from one coding system to another, particularly during the shift from ICD-9 to ICD-10 codes. It provides a systematic way to link codes from the previous coding system to the new one, which helps ensure continuity in billing and helps billers and coders in mapping diagnoses and procedures accurately. This is crucial for maintaining compliance with federal regulations and ensuring that providers receive appropriate reimbursement for services rendered. The use of GEM allows for a smoother transition and reduces the risk of errors that could lead to claim denials or payment delays for healthcare providers. The other options do not accurately reflect the meaning of GEM in the context of healthcare billing. For instance, General Enrollment Management would pertain more to patient enrollment processes rather than coding. Global Evidence Metric and Generalized Expense Model are not recognized terms within the healthcare billing domain and lack relevance in this context.