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AAPC CPB Exam Syllabus Topics:

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

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AAPC Certified Professional Biller (CPB) Sample Questions (Q60-Q65):

NEW QUESTION # 60
What does it mean by juxta?

A. near
B. far

Answer: A

NEW QUESTION # 61
Blue Worldwide Expat __________

A. provides global medical coverage for active employees and their dependents who spend more than six months outside the United States for three months or more is eligible for Blue World Expat.
B. provides global medical coverage for active employees and their dependents who spend more than three months outside the United States for six months or more is eligible for Blue World Expat.
C. provides global medical coverage for active employees and their dependents who spend more than six months outside the United States for six months or more is eligible for Blue World Expat.
D. provides global medical coverage for active employees and their dependents who spend more than three months outside the United States for three months or more is eligible for Blue World Expat.

Answer: C

NEW QUESTION # 62
GEP stands for General Enrollment Period.

A. TRUE
B. FALSE

Answer: A

NEW QUESTION # 63
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 # 64
Who is a person who performs services for another under an expressed or implied agreement?

A. Healthcare Provider
B. Independent Contractor
C. Health Insurance Specialist

Answer: B

NEW QUESTION # 65
......

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