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| Section | Weight | Objectives |
|---|
| Insurance and Reimbursement | 20-25% | - Claims submission and processing - Commercial insurance policies - Government payers (Medicare, Medicaid, TRICARE) - Coordination of benefits - Workers' compensation and no-fault billing - Fee schedules and reimbursement methodologies
|
| Billing Compliance and Regulations | 10-15% | - Fraud, waste, and abuse prevention - Documentation compliance - Appeal and denial management - HIPAA privacy and security requirements - Stark Law and Anti-Kickback Statute basics
|
| ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - Secondary diagnosis coding - Chapter-specific guidelines - ICD-10-CM structure and conventions - Principal diagnosis selection
|
| Healthcare Billing Fundamentals | 15-20% | - Anatomy and physiology for billers - Healthcare documentation principles - Medical terminology basics - Revenue cycle overview
|
| Practice Management | 10-15% | - Patient responsibility calculations - Accounts receivable management - Insurance verification processes - Patient registration and demographics - Collections and payment posting
|
| CPT Coding | 20-25% | - Category II and III codes - Surgical procedure codes - Modifiers and their appropriate use - CPT code categories and structure - Evaluation and Management (E/M) codes
|
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AAPC Certified Professional Biller (CPB) Sample Questions (Q208-Q213):
NEW QUESTION # 208
What is Blue Cross (BC)?
- A. Insurance plan created in 1929 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 21 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
- B. Insurance plan created in 1930 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 20 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
- C. Insurance plan created in 1929 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 20 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
- D. Insurance plan created in 1930 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 21 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
Answer: A
NEW QUESTION # 209
ARPDRG refers to All Patient Refined DiagnosisRelated Group.
Answer: B
NEW QUESTION # 210
The medical prefix "dys-" means:
- A. bad, painful
- B. blood condition
- C. excision, removal
- D. vomiting
Answer: A
NEW QUESTION # 211
anti
- A. condition
- B. against
- C. joint
Answer: B
NEW QUESTION # 212
Which part of the body does cardi refer to?
- A. head
- B. vagina
- C. neck
- D. heart
Answer: D
NEW QUESTION # 213
......
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