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| Section | Weight | Objectives |
|---|
| Topic 1: ICD-10-CM Diagnosis Coding | 15-20% | - Chapter-specific guidelines - ICD-10-CM structure and conventions - Code accuracy and specificity - Secondary diagnosis coding - Principal diagnosis selection
|
| Topic 2: Healthcare Billing Fundamentals | 15-20% | - Anatomy and physiology for billers - Revenue cycle overview - Medical terminology basics - Healthcare documentation principles
|
| Topic 3: CPT Coding | 20-25% | - Evaluation and Management (E/M) codes - Category II and III codes - Modifiers and their appropriate use - CPT code categories and structure - Surgical procedure codes
|
| Topic 4: Billing Compliance and Regulations | 10-15% | - Appeal and denial management - Documentation compliance - Fraud, waste, and abuse prevention - HIPAA privacy and security requirements - Stark Law and Anti-Kickback Statute basics
|
| Topic 5: Insurance and Reimbursement | 20-25% | - Commercial insurance policies - Claims submission and processing - Fee schedules and reimbursement methodologies - Coordination of benefits - Government payers (Medicare, Medicaid, TRICARE) - Workers' compensation and no-fault billing
|
| Topic 6: Practice Management | 10-15% | - Collections and payment posting - Patient responsibility calculations - Insurance verification processes - Accounts receivable management - Patient registration and demographics
|
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AAPC Certified Professional Biller (CPB) Sample Questions (Q26-Q31):
NEW QUESTION # 26
The medical word root "ileo" refers to the:
- A. ileum (small intestine)
- B. within, into
- C. ilium (hip bone)
- D. in, into, not
Answer: A
NEW QUESTION # 27
The medical prefix "hyper-" means:
- A. condition
- B. uterus, womb
- C. above, excessive
Answer: C
NEW QUESTION # 28
CPT
- A. CHAMPUS Reform Initiative
- B. Customized SubCapitation Plan
- C. Current Procedural Terminology
- D. Computed Tomography
Answer: C
NEW QUESTION # 29
EPO
- A. Exclusive provider organization
- B. Early and Periodic screening, diagnostic, and treatment
- C. Electronic Remittance Advice
- D. External Quality Review Organization
Answer: A
NEW QUESTION # 30
What does the acronym ERISA stand for?
- A. Fair Debt Collection Practices Act
- B. Employee Retirements Income Security Act of 1974
- C. First Look Analysis for Hospital Outlier Monitoring
- D. False Claims Act
Answer: B
NEW QUESTION # 31
......
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