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AAPC CPB Exam Syllabus Topics:

SectionWeightObjectives
Case Analysis17%- End-to-end billing scenarios
- Adjudication and resolution
- Eligibility verification
Types of Insurance21%- Managed care plans
- TRICARE/CHAMPUS, Workers' compensation
- Third-party liability
- Commercial payers
- Medicare, Medigap, Medicaid
Coding Concepts for Billers12%- Medical necessity
- ICD-10-CM, CPT®, HCPCS Level II
- Code validation, modifiers
Claims and Billing14%- Denials, appeals, corrections
- Timely filing rules
- Electronic claims, clearinghouses
- Claim submission, tracking, follow-up
Reimbursement and Collections14%- Patient statements, collections
- Payment posting, adjustments
- Refunds, payment plans, write-offs
- Accounts receivable management
HIPAA and Compliance9%- Privacy, security, transaction standards
- Compliance programs
- Medical record retention
- Fraud, abuse, False Claims Act
Billing Regulations13%- CMS-1500, UB-04 completion
- Incident-to billing, global packages
- ACOs, NCCI, LCDs, NCDs
- Payer payment policies

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AAPC Certified Professional Biller (CPB) Sample Questions (Q85-Q90):

NEW QUESTION # 85
Catchment area is the region defined by code boundaries within a 40mile radius of a military treatment facility.

Answer: B


NEW QUESTION # 86
What does the acronym EHR stand for?

Answer: A


NEW QUESTION # 87
anti

Answer: B


NEW QUESTION # 88
When is an Advance Beneficiary Notice (ABN) required?

Answer: B

Explanation:
An ABN informs Medicare patients that they may be financially responsible if coverage is denied.


NEW QUESTION # 89
Case mix includes the types and categories of patients treated by a healthcare provider.

Answer: B


NEW QUESTION # 90
......

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