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| Section | Weight | Objectives |
|---|
| Topic 1: Healthcare Billing Fundamentals | 15-20% | - Anatomy and physiology for billers - Healthcare documentation principles - Revenue cycle overview - Medical terminology basics
|
| Topic 2: ICD-10-CM Diagnosis Coding | 15-20% | - Secondary diagnosis coding - Chapter-specific guidelines - Principal diagnosis selection - Code accuracy and specificity - ICD-10-CM structure and conventions
|
| Topic 3: Practice Management | 10-15% | - Insurance verification processes - Accounts receivable management - Patient responsibility calculations - Patient registration and demographics - Collections and payment posting
|
| Topic 4: CPT Coding | 20-25% | - Surgical procedure codes - Category II and III codes - CPT code categories and structure - Evaluation and Management (E/M) codes - Modifiers and their appropriate use
|
| Topic 5: Billing Compliance and Regulations | 10-15% | - Stark Law and Anti-Kickback Statute basics - Appeal and denial management - Fraud, waste, and abuse prevention - Documentation compliance - HIPAA privacy and security requirements
|
| Topic 6: Insurance and Reimbursement | 20-25% | - Government payers (Medicare, Medicaid, TRICARE) - Commercial insurance policies - Fee schedules and reimbursement methodologies - Coordination of benefits - Claims submission and processing - Workers' compensation and no-fault billing
|
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AAPC Certified Professional Biller (CPB) Sample Questions (Q75-Q80):
NEW QUESTION # 75
APDRG refers to All Patient DiagnosisRelated Group.
Answer: B
NEW QUESTION # 76
What does HA stand for?
- A. Healthcare Affairs
- B. Home Assessment
- C. Healthcare Assessment
- D. Health Affairs
Answer: D
NEW QUESTION # 77
ilio
- A. ilium (hip bone)
- B. within, into
- C. between
- D. in, into, not
Answer: A
NEW QUESTION # 78
CMS1500
- A. Clinical nurse specialist
- B. Coordination of Benefits
- C. Insurance claim used by noninstitutional providers and supplier to bill payers
- D. Consolidated Omnibus Budget Reconciliation Act of 1985
Answer: C
NEW QUESTION # 79
What is the amount owed to a business for services or goods provided?
- A. Accounts Receivable
- B. Accounts Billing
- C. Accounts Payable
- D. Accrued Revenue
Answer: A
NEW QUESTION # 80
......
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