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AAPC CPB Exam Syllabus Topics:

Section	Objectives
Topic 1: Medical Billing Fundamentals	- Medical billing workflow and revenue cycle - Insurance types and payer structures - Healthcare reimbursement systems
Topic 2: Compliance and Regulations	- Fraud and abuse prevention - Billing compliance standards - HIPAA and patient privacy rules
Topic 3: Revenue Cycle Management	- Claims denial and rejection management - Payment posting and reconciliation - Accounts receivable follow-up
Topic 4: Insurance Processing and Payer Rules	- Private insurance policies and contracts - Medicare and Medicaid guidelines - Coordination of benefits (COB)
Topic 5: Coding and Claim Submission Basics	- Claims submission processes - Use of modifiers and coding compliance - ICD-10-CM, CPT, and HCPCS overview

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CPB New Questions | Reliable CPB Test Syllabus

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AAPC Certified Professional Biller (CPB) Sample Questions (Q237-Q242):

NEW QUESTION # 237
Which payer typically requires prior authorization for certain services?

A. Medicaid only
B. Only Medicare
C. Commercial and managed care plans
D. All payers equally

Answer: C

Explanation:
Commercial and managed care plans frequently require prior authorization.

NEW QUESTION # 238
Benefit period (Medicare) __________

A. begins with the first day of hospitalization and ends when the patient has been out of the hospital for 120 consecutive days.
B. begins with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days.
C. begins with the first day of hospitalization and ends when the patient has been out of the hospital for 90 consecutive days.
D. begins with the first day of hospitalization and ends when the patient has been out of the hospital for 30 consecutive days.

Answer: B

NEW QUESTION # 239
HICN stands for Health Insurance claim number.

A. FALSE
B. TRUE

Answer: B

NEW QUESTION # 240
What is All Patient Refined DiagnosisRelated Group (ARPDRG)?

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: B

NEW QUESTION # 241
Which of the following suffixes does NOT mean blood?

A. hem
B. hema
C. dacry
D. hemat

Answer: C

NEW QUESTION # 242
......

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