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| Section | Weight | Objectives |
|---|
| Billing Compliance and Regulations | 10-15% | - Appeal and denial management - Stark Law and Anti-Kickback Statute basics - HIPAA privacy and security requirements - Fraud, waste, and abuse prevention - Documentation compliance
|
| Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Medical terminology basics - Anatomy and physiology for billers - Healthcare documentation principles
|
| Practice Management | 10-15% | - Accounts receivable management - Insurance verification processes - Collections and payment posting - Patient registration and demographics - Patient responsibility calculations
|
| Insurance and Reimbursement | 20-25% | - Claims submission and processing - Commercial insurance policies - Fee schedules and reimbursement methodologies - Coordination of benefits - Government payers (Medicare, Medicaid, TRICARE) - Workers' compensation and no-fault billing
|
| CPT Coding | 20-25% | - CPT code categories and structure - Modifiers and their appropriate use - Surgical procedure codes - Category II and III codes - Evaluation and Management (E/M) codes
|
| ICD-10-CM Diagnosis Coding | 15-20% | - Secondary diagnosis coding - Chapter-specific guidelines - ICD-10-CM structure and conventions - Code accuracy and specificity - Principal diagnosis selection
|
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AAPC Certified Professional Biller (CPB) Sample Questions (Q47-Q52):
NEW QUESTION # 47
What document is used to transfer patient financial responsibility after insurance adjudication?
- A. Prior Authorization
- B. CMS-1500
- C. UB-04
- D. Patient Statement
Answer: D
Explanation:
A patient statement reflects remaining balances after insurance processing.
NEW QUESTION # 48
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 # 49
ad
- A. toward
- B. pertaining to
- C. fat
Answer: A
NEW QUESTION # 50
Which part of the body does crani refer to?
- A. bones
- B. skeleton
- C. skull
Answer: C
NEW QUESTION # 51
iasis
- A. eyelid
- B. short
- C. two
- D. condition
Answer: D
NEW QUESTION # 52
......
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