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| Section | Weight | Objectives |
|---|
| Insurance and Reimbursement | 20-25% | - Coordination of benefits - Claims submission and processing - Fee schedules and reimbursement methodologies - Commercial insurance policies - Government payers (Medicare, Medicaid, TRICARE) - Workers' compensation and no-fault billing
|
| Practice Management | 10-15% | - Patient registration and demographics - Collections and payment posting - Accounts receivable management - Insurance verification processes - Patient responsibility calculations
|
| Healthcare Billing Fundamentals | 15-20% | - Anatomy and physiology for billers - Medical terminology basics - Healthcare documentation principles - Revenue cycle overview
|
| CPT Coding | 20-25% | - CPT code categories and structure - Category II and III codes - Evaluation and Management (E/M) codes - Surgical procedure codes - Modifiers and their appropriate use
|
| ICD-10-CM Diagnosis Coding | 15-20% | - Secondary diagnosis coding - Chapter-specific guidelines - ICD-10-CM structure and conventions - Principal diagnosis selection - Code accuracy and specificity
|
| Billing Compliance and Regulations | 10-15% | - Appeal and denial management - Documentation compliance - Stark Law and Anti-Kickback Statute basics - HIPAA privacy and security requirements - Fraud, waste, and abuse prevention
|
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AAPC Certified Professional Biller (CPB) Sample Questions (Q216-Q221):
NEW QUESTION # 216
What does CERT stand for?
- A. Conversion Error Rate Testing
- B. Civilian Error Rate Testing
- C. Comprehensive Error Rate Testing
- D. Clinical Error Rate Testing
Answer: C
NEW QUESTION # 217
CMP
- A. Insurance claim used by noninstitutional providers and supplier to bill payers
- B. Centers of Medicare and Medicaid Services
- C. Competitive Medical Plan
- D. UB04 Claim used by institutional and other selected providers to
Answer: C
NEW QUESTION # 218
EDI
- A. Electronic funds transfer
- B. Employer group health plan
- C. Electronic data interchange
- D. Electronic Healthcare Network Accreditation Commission
Answer: C
NEW QUESTION # 219
What does it mean by inter?
- A. outside
- B. between
- C. inside
Answer: B
NEW QUESTION # 220
837
- A. Claims validation table (as in ANSI ASC X13 837)
- B. Claims validation table (as in ANSI ASC X11 837)
- C. Claims validation table (as in ANSI ASC X12 837)
- D. Claims validation table (as in ANSI ASC X10 837)
Answer: C
NEW QUESTION # 221
......
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