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| Section | Weight | Objectives |
|---|
| Topic 1: Insurance and Reimbursement | 20-25% | - Commercial insurance policies - Workers' compensation and no-fault billing - Claims submission and processing - Government payers (Medicare, Medicaid, TRICARE) - Coordination of benefits - Fee schedules and reimbursement methodologies
|
| Topic 2: Practice Management | 10-15% | - Accounts receivable management - Patient registration and demographics - Collections and payment posting - Patient responsibility calculations - Insurance verification processes
|
| Topic 3: Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Medical terminology basics - Healthcare documentation principles - Anatomy and physiology for billers
|
| Topic 4: 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
|
| Topic 5: ICD-10-CM Diagnosis Coding | 15-20% | - Secondary diagnosis coding - Chapter-specific guidelines - Principal diagnosis selection - ICD-10-CM structure and conventions - Code accuracy and specificity
|
| Topic 6: CPT Coding | 20-25% | - Category II and III codes - Evaluation and Management (E/M) codes - Modifiers and their appropriate use - CPT code categories and structure - Surgical procedure codes
|
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AAPC Certified Professional Biller (CPB) Sample Questions (Q165-Q170):
NEW QUESTION # 165
What are Category III codes?
- A. Procedures/ services identified by a five digit CPT code and descriptor nomenclature; these codes are traditionally associated with CPT and organized within six sections.
- B. Temporary codes for data collection purposes that are assigned an alphanumeric identifier with a letter in the last field (e.g., 0001T) these codes are located after the Medicine section, and will be archived after five years unless accepted for placement within Category I sections of CPT.
- C. Optional performance measurement tracking codes that are field (e,g.,1234A); these codes will be located after the medicine section; their use is optional.
Answer: B
NEW QUESTION # 166
Blue Worldwide Expat __________
- A. 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.
- 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 three months or more is eligible for Blue World Expat.
- D. 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.
Answer: D
NEW QUESTION # 167
in
- A. between
- B. in, into, not
- C. within, into
Answer: B
NEW QUESTION # 168
What does AAMA stand for?
- A. Australian Association of Medical Assistants
- B. African Association of Medical Assistants
- C. Asian Association of Medical Assistants
- D. American Association of Medical Assistants
Answer: D
NEW QUESTION # 169
What does it mean by derm and dermat?
- A. nail
- B. bones
- C. blood
- D. skin
Answer: D
NEW QUESTION # 170
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