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AAPC CPB Exam Syllabus Topics:

Section	Weight	Objectives
Insurance and Reimbursement	20-25%	- Workers' compensation and no-fault billing - Fee schedules and reimbursement methodologies - Government payers (Medicare, Medicaid, TRICARE) - Commercial insurance policies - Coordination of benefits - Claims submission and processing
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
Practice Management	10-15%	- Insurance verification processes - Patient registration and demographics - Accounts receivable management - Patient responsibility calculations - Collections and payment posting
Billing Compliance and Regulations	10-15%	- Appeal and denial management - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics - HIPAA privacy and security requirements - Documentation compliance
CPT Coding	20-25%	- Surgical procedure codes - Category II and III codes - Modifiers and their appropriate use - CPT code categories and structure - Evaluation and Management (E/M) codes
Healthcare Billing Fundamentals	15-20%	- Medical terminology basics - Anatomy and physiology for billers - Revenue cycle overview - Healthcare documentation principles

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AAPC Certified Professional Biller (CPB) Sample Questions (Q202-Q207):

NEW QUESTION # 202
CPT

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

Answer: B

NEW QUESTION # 203
What is All Patient Refined DiagnosisRelated Group (ARPDRG)?

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: A

NEW QUESTION # 204
What is All Patient DiagnosisRelated Group (APDRG)?

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: A

NEW QUESTION # 205
Catchment area is the region defined by code boundaries within a 40mile radius of a military treatment facility.

A. FALSE
B. TRUE

Answer: B

NEW QUESTION # 206
What is Ambulatory Surgical Center Payment Rate?

A. Predetermined amount for which ASC services are reimbursed, at 80 percent before adjustment for regional wage variations.
B. Determined amount for which ASC services are reimbursed, at 80 percent after adjustment for regional wage variations.
C. Determined amount for which ASC services are reimbursed, at 80 percent before adjustment for regional wage variations.
D. Predetermined amount for which ASC services are reimbursed, at 80 percent after adjustment for regional wage variations.

Answer: D

NEW QUESTION # 207
......

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