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AAPC CPB Exam Syllabus Topics:

Section	Weight	Objectives
Healthcare Billing Fundamentals	15-20%	- Healthcare documentation principles - Medical terminology basics - Anatomy and physiology for billers - Revenue cycle overview
Billing Compliance and Regulations	10-15%	- HIPAA privacy and security requirements - Documentation compliance - Stark Law and Anti-Kickback Statute basics - Fraud, waste, and abuse prevention - Appeal and denial management
CPT Coding	20-25%	- Category II and III codes - Evaluation and Management (E/M) codes - Modifiers and their appropriate use - Surgical procedure codes - CPT code categories and structure
Insurance and Reimbursement	20-25%	- Government payers (Medicare, Medicaid, TRICARE) - Claims submission and processing - Fee schedules and reimbursement methodologies - Workers' compensation and no-fault billing - Coordination of benefits - Commercial insurance policies
ICD-10-CM Diagnosis Coding	15-20%	- ICD-10-CM structure and conventions - Code accuracy and specificity - Principal diagnosis selection - Secondary diagnosis coding - Chapter-specific guidelines
Practice Management	10-15%	- Insurance verification processes - Patient registration and demographics - Patient responsibility calculations - Accounts receivable management - Collections and payment posting

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AAPC Certified Professional Biller (CPB) Sample Questions (Q165-Q170):

NEW QUESTION # 165
What is Ambulatory Surgical Center Payment Rate?

A. Determined amount for which ASC services are reimbursed, at 80 percent before adjustment for regional wage variations.
B. Predetermined amount for which ASC services are reimbursed, at 80 percent after adjustment for regional wage variations.
C. Predetermined amount for which ASC services are reimbursed, at 80 percent before adjustment for regional wage variations.
D. Determined amount for which ASC services are reimbursed, at 80 percent after adjustment for regional wage variations.

Answer: B

NEW QUESTION # 166
What does CF stand for?

A. Competitive Factor
B. Conversion Factor
C. Clinical Factor
D. Civilian FactorAffairs

Answer: B

NEW QUESTION # 167
DME

A. Department of Defense
B. Durable Medical Equipment, Prosthetic and Orthotic Supplies
C. Durable Medical Equipment regional carriers
D. Durable Medical Equipment

Answer: D

NEW QUESTION # 168
Adjudication

A. Payment correction resulting in additional payment(s) to the provider.
B. Judicial dispute resolution process in which an appeals board makes a final determination.
C. Document that acknowledges patient responsibility for payment if Medicare denies the claim
D. Also called adverse reaction; the appearance of a pathologic condition due to ingestion r exposure to a chemical substance properly administered or taken.

Answer: B

NEW QUESTION # 169
What is Blue Cross (BC)?

A. Insurance plan created in 1930 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 20 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
B. Insurance plan created in 1929 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 21 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
C. Insurance plan created in 1930 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 21 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
D. Insurance plan created in 1929 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 20 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.

Answer: B

NEW QUESTION # 170
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