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AAPC CPB Exam Syllabus Topics:

Section	Weight	Objectives
CPT Coding	20-25%	- Evaluation and Management (E/M) codes - Surgical procedure codes - CPT code categories and structure - Category II and III codes - Modifiers and their appropriate use
ICD-10-CM Diagnosis Coding	15-20%	- ICD-10-CM structure and conventions - Chapter-specific guidelines - Principal diagnosis selection - Code accuracy and specificity - Secondary diagnosis coding
Practice Management	10-15%	- Accounts receivable management - Insurance verification processes - Patient responsibility calculations - Patient registration and demographics - Collections and payment posting
Healthcare Billing Fundamentals	15-20%	- Medical terminology basics - Anatomy and physiology for billers - Healthcare documentation principles - Revenue cycle overview
Insurance and Reimbursement	20-25%	- Claims submission and processing - Commercial insurance policies - Workers' compensation and no-fault billing - Coordination of benefits - Government payers (Medicare, Medicaid, TRICARE) - Fee schedules and reimbursement methodologies
Billing Compliance and Regulations	10-15%	- HIPAA privacy and security requirements - Stark Law and Anti-Kickback Statute basics - Appeal and denial management - Documentation compliance - Fraud, waste, and abuse prevention

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AAPC Certified Professional Biller (CPB) Sample Questions (Q166-Q171):

NEW QUESTION # 166
DOD

A. Diagnostic and statistical manual
B. Diagnosis related groups
C. Department of Defense
D. Disproportionate share hospital (adjustment)

Answer: C

NEW QUESTION # 167
CNS

A. Clinical nurse specialist
B. Consolidated Omnibus Budget Reconciliation Act of 1985
C. Certified Professional Coder
D. Coordination of Benefits

Answer: A

NEW QUESTION # 168
The medical word root "hemat" or "hemat/o" refers to:

A. half
B. blood
C. below, under
D. liver

Answer: B

NEW QUESTION # 169
Accept Assignment

A. Assists providers in the collection of appropriate reimbursement for services rendered; include functions such as insurance verification/eligibility and preauthorization of services.
B. The amount owed to a business for services or goods provided.
C. Provider accepts as payment in full whatever is paid on the claim by the payer (except for any copayment and or coinsurance amounts.)
D. Shows the status (by date) of outstanding claims from each payer, as well as payments due from patients.

Answer: C

NEW QUESTION # 170
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.

A. TRUE
B. FALSE

Answer: A

NEW QUESTION # 171
......

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