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| Section | Weight | Objectives |
|---|
| Topic 1: CPT Coding | 20-25% | - Modifiers and their appropriate use - Evaluation and Management (E/M) codes - Category II and III codes - Surgical procedure codes - CPT code categories and structure
|
| Topic 2: Healthcare Billing Fundamentals | 15-20% | - Medical terminology basics - Healthcare documentation principles - Revenue cycle overview - Anatomy and physiology for billers
|
| Topic 3: ICD-10-CM Diagnosis Coding | 15-20% | - Principal diagnosis selection - ICD-10-CM structure and conventions - Code accuracy and specificity - Secondary diagnosis coding - Chapter-specific guidelines
|
| Topic 4: Billing Compliance and Regulations | 10-15% | - Documentation compliance - Appeal and denial management - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics - HIPAA privacy and security requirements
|
| Topic 5: Insurance and Reimbursement | 20-25% | - Coordination of benefits - Fee schedules and reimbursement methodologies - Government payers (Medicare, Medicaid, TRICARE) - Workers' compensation and no-fault billing - Commercial insurance policies - Claims submission and processing
|
| Topic 6: Practice Management | 10-15% | - Patient responsibility calculations - Patient registration and demographics - Insurance verification processes - Accounts receivable management - Collections and payment posting
|
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AAPC Certified Professional Biller (CPB) Sample Questions (Q167-Q172):
NEW QUESTION # 167
Blue Cross Blue Shield Association (BCBSA) is an association of independent Blue Cross Blue Shield plans.
Answer: A
NEW QUESTION # 168
Ambulatory Payment Classification (APC) is prospective payment system used to calculate reimbursement for outpatient care according to similar clinical characteristics and in terms of resources required.
Answer: A
NEW QUESTION # 169
HEDIS stands for Health Plan Employer Data and Information Set.
Answer: A
NEW QUESTION # 170
The medical prefix "dys-" means:
- A. vomiting
- B. excision, removal
- C. bad, painful
- D. blood condition
Answer: C
NEW QUESTION # 171
A patient has Medicare as primary and a commercial plan as secondary. Which insurance should be billed first?
- A. Secondary insurance
- B. Commercial insurance
- C. Medicaid
- D. Medicare
Answer: D
Explanation:
Medicare is billed first when it is the primary payer under coordination of benefits rules.
NEW QUESTION # 172
......
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