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AAPC CPB Exam Syllabus Topics:

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

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AAPC Certified Professional Biller (CPB) Sample Questions (Q91-Q96):

NEW QUESTION # 91
What does AMA stand for?

A. American Medical Association
B. American Military Association
C. American Management Association

Answer: A

NEW QUESTION # 92
What is All Patient Refined DiagnosisRelated Group (ARPDRG)?

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: A

NEW QUESTION # 93
What does GEM stand for?

A. General Enrollment Management
B. Geographic Equivalency Mapping
C. General Equivalency Mapping
D. Group Enrollment Management

Answer: C

NEW QUESTION # 94
Adjudication

A. Payment correction resulting in additional payment(s) to the provider.
B. Judicial dispute resolution process in which an appeals board makes a final determination.
C. Document that acknowledges patient responsibility for payment if Medicare denies the claim
D. Also called adverse reaction; the appearance of a pathologic condition due to ingestion r exposure to a chemical substance properly administered or taken.

Answer: B

NEW QUESTION # 95
What are Category II codes?

A. 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.
B. 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.
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: B

NEW QUESTION # 96
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