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AAPC CPB Exam Syllabus Topics:

Section	Weight	Objectives
HIPAA and Compliance	9%	- Fraud, abuse, False Claims Act - Medical record retention - Compliance programs - Privacy, security, transaction standards
Billing Regulations	13%	- Payer payment policies - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion
Coding Concepts for Billers	12%	- ICD-10-CM, CPT®, HCPCS Level II - Medical necessity - Code validation, modifiers
Reimbursement and Collections	14%	- Payment posting, adjustments - Refunds, payment plans, write-offs - Accounts receivable management - Patient statements, collections
Claims and Billing	14%	- Electronic claims, clearinghouses - Timely filing rules - Denials, appeals, corrections - Claim submission, tracking, follow-up
Types of Insurance	21%	- Managed care plans - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Commercial payers - Third-party liability
Case Analysis	17%	- Eligibility verification - Adjudication and resolution - End-to-end billing scenarios

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AAPC Certified Professional Biller (CPB) Sample Questions (Q46-Q51):

NEW QUESTION # 46
Catchment area is the region defined by code boundaries within a 40mile radius of a military treatment facility.

A. FALSE
B. TRUE

Answer: B

NEW QUESTION # 47
What does it mean by brachy?

A. tall
B. short

Answer: B

NEW QUESTION # 48
Amendment to the HMO Act of 1973 is legislation that allowed federally qualified HMOs to permit members to occasionally use non HMO physicians and be partially reimbursed.

A. FALSE
B. TRUE

Answer: B

NEW QUESTION # 49
de

A. skin
B. lack of, down
C. right
D. half

Answer: B

NEW QUESTION # 50
What are Category II codes?

A. Optional performance measurement tracking codes that are assigned an alphanumeric identifier with a letter in the last field (e,g.,1234A); these codes will be located after the medicine section; their use is optional.
B. Temporary codes for data collection purposes that are assigned an alphanumeric identifier with a letter in the last field (e.g., 0001T) these codes are located after the Medicine section, and will be archived after five years unless accepted for placement within Category I sections of CPT.
C. Procedures/ services identified by a five digit CPT code and descriptor nomenclature; these codes are traditionally associated with CPT and organized within six sections.

Answer: A

NEW QUESTION # 51
......

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