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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - Principal diagnosis selection - Secondary diagnosis coding - Chapter-specific guidelines - ICD-10-CM structure and conventions |
| Topic 2: Healthcare Billing Fundamentals | 15-20% | - Healthcare documentation principles - Revenue cycle overview - Anatomy and physiology for billers - Medical terminology basics |
| Topic 3: Insurance and Reimbursement | 20-25% | - Workers' compensation and no-fault billing - Claims submission and processing - Commercial insurance policies - Government payers (Medicare, Medicaid, TRICARE) - Fee schedules and reimbursement methodologies - Coordination of benefits |
| Topic 4: CPT Coding | 20-25% | - Evaluation and Management (E/M) codes - CPT code categories and structure - Surgical procedure codes - Modifiers and their appropriate use - Category II and III codes |
| Topic 5: Practice Management | 10-15% | - Patient registration and demographics - Collections and payment posting - Insurance verification processes - Accounts receivable management - Patient responsibility calculations |
| Topic 6: Billing Compliance and Regulations | 10-15% | - Fraud, waste, and abuse prevention - Appeal and denial management - Stark Law and Anti-Kickback Statute basics - HIPAA privacy and security requirements - Documentation compliance |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. Accounts Receivable Management
A) Judicial dispute resolution process in which an appeals board makes a final determination.
B) Voluntary Process that a healthcare facility or organization (e.g. hospital or managed care plan) undergoes to demonstrate that it has met standards beyond those required by law.
C) Assists providers in the collection of appropriate reimbursement for services rendered; include functions such as insurance verification/eligibility and preauthorization of services
D) Payment correction resulting in additional payment(s) to the provider.
2. Which of the following suffixes means two?
A) bi
B) hemi
C) demi
3. The medical word root "fibr" or "fibr/o" refers to:
A) milk
B) before
C) stomach
D) fiber
4. What does ANSI stand for?
A) American National Standards Information
B) American National Services Institute
C) American National Standards Institute
D) American National Services Information
5. CLIA
A) Competitive Medical Plan
B) UB04 Claim used by institutional and other selected providers to bill payers
C) Clinical Laboratory Improvement Act
D) Centers of Medicare and Medicaid Services
Solutions:
| Question # 1 Answer: C | Question # 2 Answer: A | Question # 3 Answer: D | Question # 4 Answer: C | Question # 5 Answer: C |
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