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AAPC CPB Exam Syllabus Topics:

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

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AAPC Certified Professional Biller (CPB) Sample Questions (Q86-Q91):

NEW QUESTION # 86
CPT

A. Current Procedural Terminology
B. CHAMPUS Reform Initiative
C. Customized SubCapitation Plan
D. Computed Tomography

Answer: A

NEW QUESTION # 87
BCAC stands for Beneficiary Counseling and Assistance Coordinator.

A. FALSE
B. TRUE

Answer: B

NEW QUESTION # 88
Who is the person who prepares and reviews claims for accuracy to ensure prompt payment?

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

Answer: A

NEW QUESTION # 89
What is All Patient DiagnosisRelated Group (APDRG)?

A. 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.
B. 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.

Answer: B

NEW QUESTION # 90
HIPPS stands for Health Insurance Prospective Payment System (code set).

A. FALSE
B. TRUE

Answer: B

NEW QUESTION # 91
......

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