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AAPC CPB Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Topic 1: Coding and Claim Submission Basics | - ICD-10-CM, CPT, and HCPCS overview - Use of modifiers and coding compliance - Claims submission processes |
| Topic 2: Medical Billing Fundamentals | - Insurance types and payer structures - Medical billing workflow and revenue cycle - Healthcare reimbursement systems |
| Topic 3: Compliance and Regulations | - Billing compliance standards - HIPAA and patient privacy rules - Fraud and abuse prevention |
| Topic 4: Revenue Cycle Management | - Accounts receivable follow-up - Claims denial and rejection management - Payment posting and reconciliation |
| Topic 5: Insurance Processing and Payer Rules | - Medicare and Medicaid guidelines - Coordination of benefits (COB) - Private insurance policies and contracts |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. FMAP stands for Federal Medical Assistance Percentage.
A) TRUE
B) FALSE
2. What does it mean by dextr?
A) left
B) right
3. Ambulatory Payment Classification (APC) is prospective payment system used to calculate reimbursement for outpatient care according to similar clinical characteristics and in terms of resources required.
A) TRUE
B) FALSE
4. Accounts Receivable Management
A) 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.
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) Assists providers in the collection of appropriate reimbursement for services rendered; include functions such as insurance verification/eligibility and preauthorization of services
5. Medical Ethics are principles of right or good conduct.
A) TRUE
B) FALSE
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: B | Question # 3 Answer: A | Question # 4 Answer: D | Question # 5 Answer: A |
