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| Section | Weight | Objectives |
|---|
| Topic 1: Healthcare Billing Fundamentals | 15-20% | - Healthcare documentation principles - Anatomy and physiology for billers - Medical terminology basics - Revenue cycle overview
|
| Topic 2: ICD-10-CM Diagnosis Coding | 15-20% | - ICD-10-CM structure and conventions - Code accuracy and specificity - Chapter-specific guidelines - Principal diagnosis selection - Secondary diagnosis coding
|
| Topic 3: Billing Compliance and Regulations | 10-15% | - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics - Documentation compliance - HIPAA privacy and security requirements - Appeal and denial management
|
| Topic 4: Practice Management | 10-15% | - Patient registration and demographics - Insurance verification processes - Patient responsibility calculations - Collections and payment posting - Accounts receivable management
|
| Topic 5: CPT Coding | 20-25% | - Evaluation and Management (E/M) codes - Surgical procedure codes - Category II and III codes - CPT code categories and structure - Modifiers and their appropriate use
|
| Topic 6: Insurance and Reimbursement | 20-25% | - Fee schedules and reimbursement methodologies - Workers' compensation and no-fault billing - Government payers (Medicare, Medicaid, TRICARE) - Claims submission and processing - Commercial insurance policies - Coordination of benefits
|
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AAPC Certified Professional Biller (CPB) Sample Questions (Q79-Q84):
NEW QUESTION # 79
FATHOM
- A. Fair Debt Collection Practices Act
- B. False Claims Act
- C. First Look Analysis for Hospital Outlier Monitoring
- D. Federal Employment Compensation Act
Answer: C
NEW QUESTION # 80
BCBS stands for Blue Cross Blue Shield.
Answer: B
NEW QUESTION # 81
FMAP stands for Federal Medical Assistance Percentage.
Answer: B
NEW QUESTION # 82
Adverse Effect is also called adverse reaction; the appearance of a pathologic condition due to ingestion r exposure to a chemical substance properly administered or taken.
Answer: B
NEW QUESTION # 83
CSCP
- A. Customized SubCapitation Plan
- B. Computed Tomography
- C. Debt Collection Assistance Officer
- D. Defense Enrollment Eligibility Reporting System
Answer: A
NEW QUESTION # 84
......
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