AAPC CPB Latest Test Cram - CPB Valid Test Cram

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AAPC CPB Exam Syllabus Topics:

Section	Weight	Objectives
Topic 1: Case Analysis	17%	- Adjudication and resolution - End-to-end billing scenarios - Eligibility verification
Topic 2: Types of Insurance	21%	- Medicare, Medigap, Medicaid - Managed care plans - Third-party liability - Commercial payers - TRICARE/CHAMPUS, Workers' compensation
Topic 3: HIPAA and Compliance	9%	- Medical record retention - Privacy, security, transaction standards - Compliance programs - Fraud, abuse, False Claims Act
Topic 4: Claims and Billing	14%	- Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Timely filing rules - Denials, appeals, corrections
Topic 5: Coding Concepts for Billers	12%	- Medical necessity - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers
Topic 6: Billing Regulations	13%	- Incident-to billing, global packages - Payer payment policies - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion
Topic 7: Reimbursement and Collections	14%	- Payment posting, adjustments - Refunds, payment plans, write-offs - Accounts receivable management - Patient statements, collections

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AAPC Certified Professional Biller (CPB) Sample Questions (Q85-Q90):

NEW QUESTION # 85
What is All Patient Refined DiagnosisRelated Group (ARPDRG)?

A. DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to nonMedicare beneficiaries (e.g. Blue Cross BlueShield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources.
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 severity of illness (SOI) (extent of physiological decompensation or organ system loss of function) and risk of mortality (ROM) (likelihood of dying); each subclass, in turn, is subdivided into four areas: (1) minor, (2) moderate, (3) major, (4) extreme.

Answer: B

NEW QUESTION # 86
CAC (Choose two.)

A. Common Access Card
B. Certified Coding Specialist
C. Computerized Axial Tomography
D. Computer Assisted Coding

Answer: A,D

NEW QUESTION # 87
Accounts Receivable Management

A. 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.
B. Payment correction resulting in additional payment(s) to the provider.
C. Judicial dispute resolution process in which an appeals board makes a final determination.
D. Assists providers in the collection of appropriate reimbursement for services rendered; include functions such as insurance verification/eligibility and preauthorization of services

Answer: D

NEW QUESTION # 88
Which payer typically requires prior authorization for certain services?

A. Medicaid only
B. Commercial and managed care plans
C. Only Medicare
D. All payers equally

Answer: B

Explanation:
Commercial and managed care plans frequently require prior authorization.

NEW QUESTION # 89
What should be done if an insurance company incorrectly denies a covered service?

A. Write off the charge
B. Resubmit the same claim without changes
C. File an appeal with supporting documentation
D. Bill the patient immediately

Answer: C

Explanation:
Appeals require corrected information and documentation to support payment.

NEW QUESTION # 90
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