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AAPC CPB Exam Syllabus Topics:

Section	Objectives
Topic 1: Compliance and Regulations	- Billing compliance standards - Fraud and abuse prevention - HIPAA and patient privacy rules
Topic 2: Insurance Processing and Payer Rules	- Medicare and Medicaid guidelines - Private insurance policies and contracts - Coordination of benefits (COB)
Topic 3: Medical Billing Fundamentals	- Insurance types and payer structures - Medical billing workflow and revenue cycle - Healthcare reimbursement systems
Topic 4: Coding and Claim Submission Basics	- ICD-10-CM, CPT, and HCPCS overview - Use of modifiers and coding compliance - Claims submission processes
Topic 5: Revenue Cycle Management	- Payment posting and reconciliation - Claims denial and rejection management - Accounts receivable follow-up

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

NEW QUESTION # 106
Allowable Charge

A. The Maximum amount the payer will reimburse for each procedure or service, according to the patients policy.
B. Adopted by Medicare in 2008 to reimburse hospitals for inpatient care provided to Medicare beneficiaries; expanded original DRG system (based on intensity of resources) to add two subclasses to each DRG that adjusts Medicare inpatient hospital reimbursement rates for of mortality (ROM) (likelihood of dying); each subclass, in turn, is subdivided into four areas: (1) minor, (2) moderate, (3) major, (4) extreme.
C. See limiting charge; maximum fee a physician may charge.
D. DRG system adapted for use by thirdparty payers to reimburse hospitals for inpatient care provided to nonMedicare beneficiaries (e.g. Blue Cross Blue Shield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources.

Answer: C

NEW QUESTION # 107
GPWW stands for Group Practice Without Walls.

A. TRUE
B. FALSE

Answer: A

NEW QUESTION # 108
The medical prefixes "hypo-" or "hyp-" mean:

A. above, excessive
B. below, under
C. uterus, womb
D. condition

Answer: B

NEW QUESTION # 109
What does the acronym FSA stand for?

A. General Enrollment Period
B. Flexible Spending Account
C. General Equivalency Mapping
D. Geographic Cost Practice Index

Answer: B

NEW QUESTION # 110
COB

A. Coordination of Benefits
B. Current Procedural Terminology
C. Certified Professional Coder
D. Consolidated Omnibus Budget Reconciliation Act of 1985

Answer: A

NEW QUESTION # 111
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