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AAPC CPB Exam Syllabus Topics:

Section	Weight	Objectives
Billing Compliance and Regulations	10-15%	- Documentation compliance - Appeal and denial management - HIPAA privacy and security requirements - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics
Healthcare Billing Fundamentals	15-20%	- Anatomy and physiology for billers - Medical terminology basics - Healthcare documentation principles - Revenue cycle overview
Insurance and Reimbursement	20-25%	- Claims submission and processing - Government payers (Medicare, Medicaid, TRICARE) - Fee schedules and reimbursement methodologies - Coordination of benefits - Commercial insurance policies - Workers' compensation and no-fault billing
CPT Coding	20-25%	- Category II and III codes - CPT code categories and structure - Surgical procedure codes - Evaluation and Management (E/M) codes - Modifiers and their appropriate use
ICD-10-CM Diagnosis Coding	15-20%	- Code accuracy and specificity - Chapter-specific guidelines - Secondary diagnosis coding - ICD-10-CM structure and conventions - Principal diagnosis selection
Practice Management	10-15%	- Patient registration and demographics - Collections and payment posting - Patient responsibility calculations - Insurance verification processes - Accounts receivable management

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AAPC Certified Professional Biller (CPB) Sample Questions (Q81-Q86):

NEW QUESTION # 81
EHNAC

A. Electronic Healthcare Network Accreditation Commission
B. Electronic Media Claim
C. Evaluation and Management
D. Electronic Health Record

Answer: A

NEW QUESTION # 82
What does it mean by juxta?

A. far
B. near

Answer: B

NEW QUESTION # 83
What is Allowed Charge?

A. The amount the payer will reimburse for each procedure or service, according to the patients policy.
B. The Minimum amount the payer will reimburse for each procedure or service, according to the patients policy.
C. The Maximum amount the payer will reimburse for each procedure or service, according to the patients policy.

Answer: C

NEW QUESTION # 84
Accounts Receivable Management

A. Assists providers in the collection of appropriate reimbursement for services rendered; include functions such as insurance verification/eligibility and preauthorization of services
B. Judicial dispute resolution process in which an appeals board makes a final determination.
C. Payment correction resulting in additional payment(s) to the provider.
D. Voluntary Process that a healthcare facility or organization (e.g. hospital or managed care plan) undergoes to demonstrate that it has met standards beyond those required by law.

Answer: A

NEW QUESTION # 85
DME

A. Durable Medical Equipment regional carriers
B. Department of Defense
C. Durable Medical Equipment
D. Durable Medical Equipment, Prosthetic and Orthotic Supplies

Answer: C

NEW QUESTION # 86
......

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