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| Section | Weight | Objectives |
|---|
| Topic 1: Insurance and Reimbursement | 20-25% | - Claims submission and processing - Workers' compensation and no-fault billing - Fee schedules and reimbursement methodologies - Commercial insurance policies - Coordination of benefits - Government payers (Medicare, Medicaid, TRICARE)
|
| Topic 2: Practice Management | 10-15% | - Patient responsibility calculations - Insurance verification processes - Collections and payment posting - Patient registration and demographics - Accounts receivable management
|
| Topic 3: Healthcare Billing Fundamentals | 15-20% | - Healthcare documentation principles - Revenue cycle overview - Anatomy and physiology for billers - Medical terminology basics
|
| Topic 4: ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - Chapter-specific guidelines - ICD-10-CM structure and conventions - Secondary diagnosis coding - Principal diagnosis selection
|
| Topic 5: Billing Compliance and Regulations | 10-15% | - Documentation compliance - Appeal and denial management - Stark Law and Anti-Kickback Statute basics - Fraud, waste, and abuse prevention - HIPAA privacy and security requirements
|
| Topic 6: CPT Coding | 20-25% | - CPT code categories and structure - Surgical procedure codes - Category II and III codes - Evaluation and Management (E/M) codes - Modifiers and their appropriate use
|
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AAPC Certified Professional Biller (CPB) Sample Questions (Q124-Q129):
NEW QUESTION # 124
What does it mean by cyan?
- A. green
- B. red
- C. yellow
- D. blue
Answer: D
NEW QUESTION # 125
CLIA
- A. Centers of Medicare and Medicaid Services
- B. Competitive Medical Plan
- C. UB04 Claim used by institutional and other selected providers to bill payers
- D. Clinical Laboratory Improvement Act
Answer: D
NEW QUESTION # 126
ASC (Choose two.)
- A. Ambulatory Surgical Center
- B. Beneficiary Counseling and Assistance Coordinator
- C. Blue Cross
- D. Accredited Standards Committee
Answer: A,D
NEW QUESTION # 127
BlueCard Program is program that allows BCBS subscribers to receive local Blue Plan healthcare benefits while traveling or living outside of their plan's area.
Answer: A
NEW QUESTION # 128
When is an Advance Beneficiary Notice (ABN) required?
- A. After the service is denied
- B. Only for inpatient services
- C. For all Medicare services
- D. When a service is expected to be denied as not medically necessary
Answer: D
Explanation:
An ABN informs Medicare patients that they may be financially responsible if coverage is denied.
NEW QUESTION # 129
......
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