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AAPC CPB Exam Syllabus Topics:

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

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AAPC Certified Professional Biller (CPB) Sample Questions (Q44-Q49):

NEW QUESTION # 44
BCBS stands for Blue Cross Blue Shield.

A. TRUE
B. FALSE

Answer: A

NEW QUESTION # 45
What are Category I Codes?

A. Optional performance measurement tracking codes that are assigned an alphanumeric identifier with a letter in the last field (e,g.,1234A); these codes will be located after the medicine section; their use is optional.
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. Procedures/ services identified by a five digit CPT code and descriptor nomenclature; these codes are traditionally associated with CPT and organized within six sections.

Answer: C

NEW QUESTION # 46
What is All Patient DiagnosisRelated Group (APDRG)?

A. 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.
B. 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.

Answer: B

NEW QUESTION # 47
DMERC

A. Durable Medical Equipment regional carriers
B. Disproportionate share hospital (adjustment)
C. Diagnosis related groups
D. Department of Defense

Answer: A

NEW QUESTION # 48
COBRA

A. Current Procedural Terminology
B. Consolidated Omnibus Budget Reconciliation Act of 1985
C. CHAMPUS Reform Initiative
D. Certified Professional Coder

Answer: B

NEW QUESTION # 49
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