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AAPC CPB Exam Syllabus Topics:

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

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AAPC Certified Professional Biller (CPB) Sample Questions (Q106-Q111):

NEW QUESTION # 106
The medical word root "hyster" or "hyster/o" refers to the:

A. pertaining to
B. uterus, womb
C. condition

Answer: B

NEW QUESTION # 107
Which of the following suffixes means half?

A. di
B. bi
C. demi

Answer: C

NEW QUESTION # 108
Which situation is considered billing fraud?

A. Appealing a denied claim
B. Typographical error on a claim
C. Billing for services not rendered
D. Late claim submission

Answer: C

Explanation:
Billing for services not provided is considered fraudulent activity.

NEW QUESTION # 109
Accounts Receivable Aging Report

A. Shows the status (by date) of outstanding claims from each payer, as well as payments due from patients.
B. Judicial dispute resolution process in which an appeals board makes a final determination.
C. Assists Providers in the collection of appropriate reimbursement for services rendered; include functions such as insurance verification/eligibility and preauthorization of services.
D. 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.

Answer: A

NEW QUESTION # 110
DOD

A. Department of Defense
B. Diagnosis related groups
C. Diagnostic and statistical manual
D. Disproportionate share hospital (adjustment)

Answer: A

NEW QUESTION # 111
......

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