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AAPC CPB Exam Syllabus Topics:

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

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AAPC Certified Professional Biller (CPB) Sample Questions (Q223-Q228):

NEW QUESTION # 223
What does "timely filing" refer to?

A. Electronic claim submission
B. Same-day billing
C. Submitting claims within payer-specific deadlines
D. Submitting claims quickly

Answer: C

Explanation:
Timely filing means submitting claims within the time limits set by the payer.

NEW QUESTION # 224
Which term refers to a digital version of a patient's paper chart, encompassing a comprehensive record of patient health information?

A. Early and Periodic screening, diagnostic, and treatment
B. Electronic Medical Record
C. Exclusive provider organization
D. Explanation of Benefits

Answer: B

NEW QUESTION # 225
Allowable Charge

A. See limiting charge; maximum fee a physician may charge.
B. DRG system adapted for use by thirdparty payers to reimburse hospitals for inpatient care provided to nonMedicare beneficiaries (e.g. Blue Cross Blue Shield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources.
C. 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 of mortality (ROM) (likelihood of dying); each subclass, in turn, is subdivided into four areas: (1) minor, (2) moderate, (3) major, (4) extreme.
D. The Maximum amount the payer will reimburse for each procedure or service, according to the patients policy.

Answer: A

NEW QUESTION # 226
What does the acronym E/M stand for in medical coding?

A. Evaluation and Management
B. Electronic Medical Record
C. Explanation of Benefits
D. Electronic Media Claim

Answer: A

NEW QUESTION # 227
HIPPS stands for Health Insurance Prospective Payment System (code set).

A. FALSE
B. TRUE

Answer: B

NEW QUESTION # 228
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