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| Section | Weight | Objectives |
|---|
| Topic 1: CPT Coding | 20-25% | - Modifiers and their appropriate use - Category II and III codes - Surgical procedure codes - Evaluation and Management (E/M) codes - CPT code categories and structure
|
| Topic 2: Healthcare Billing Fundamentals | 15-20% | - Medical terminology basics - Healthcare documentation principles - Revenue cycle overview - Anatomy and physiology for billers
|
| Topic 3: Practice Management | 10-15% | - Collections and payment posting - Patient responsibility calculations - Accounts receivable management - Patient registration and demographics - Insurance verification processes
|
| Topic 4: ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - ICD-10-CM structure and conventions - Chapter-specific guidelines - Principal diagnosis selection - Secondary diagnosis coding
|
| Topic 5: Insurance and Reimbursement | 20-25% | - Fee schedules and reimbursement methodologies - Government payers (Medicare, Medicaid, TRICARE) - Claims submission and processing - Commercial insurance policies - Coordination of benefits - Workers' compensation and no-fault billing
|
| Topic 6: Billing Compliance and Regulations | 10-15% | - Fraud, waste, and abuse prevention - HIPAA privacy and security requirements - Stark Law and Anti-Kickback Statute basics - Appeal and denial management - Documentation compliance
|
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AAPC Certified Professional Biller (CPB) Sample Questions (Q183-Q188):
NEW QUESTION # 183
in
- A. within, into
- B. between
- C. in, into, not
Answer: C
NEW QUESTION # 184
GEP stands for General Enrollment Period.
Answer: B
NEW QUESTION # 185
CRI
- A. Customized SubCapitation Plan
- B. Debt Collection Assistance Officer
- C. CHAMPUS Reform Initiative
- D. Computed Tomography
Answer: C
NEW QUESTION # 186
The medical word root "ileo" refers to the:
- A. within, into
- B. ileum (small intestine)
- C. ilium (hip bone)
- D. in, into, not
Answer: B
NEW QUESTION # 187
When is an Advance Beneficiary Notice (ABN) required?
- A. When a service is expected to be denied as not medically necessary
- B. For all Medicare services
- C. Only for inpatient services
- D. After the service is denied
Answer: A
Explanation:
An ABN informs Medicare patients that they may be financially responsible if coverage is denied.
NEW QUESTION # 188
......
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