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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Compliance programs - Privacy, security, transaction standards - Medical record retention |
| Claims and Billing | 14% | - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Denials, appeals, corrections - Timely filing rules |
| Types of Insurance | 21% | - Commercial payers - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Third-party liability |
| Reimbursement and Collections | 14% | - Accounts receivable management - Payment posting, adjustments - Refunds, payment plans, write-offs - Patient statements, collections |
| Billing Regulations | 13% | - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Payer payment policies |
| Case Analysis | 17% | - End-to-end billing scenarios - Adjudication and resolution - Eligibility verification |
| Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
AAPC Certified Professional Biller (CPB) Sample Questions:
Question 1
Which document is mailed by the payer to the patient to illustrate the reimbrsement amount of a covered benefit?
A. Centers of Medicare and Medicaid Services150 (CMS1500)
B. Explanation of Benefits
C. Hold Harmless Clause
D. Health Insurance Claim
Question 2
Which payer typically requires prior authorization for certain services?
A. Only Medicare
B. Medicaid only
C. All payers equally
D. Commercial and managed care plans
Question 3
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.
Question 4
What does CCS stand for?
A. Certified Coding Standards
B. Certified Coding Services
C. Certified Coding Specialist
Question 5
What does it mean by angi?
A. vein
B. artery
C. vessel
Solutions:
| Question 1 Answer: B | Question 2 Answer: D | Question 3 Answer: A | Question 4 Answer: C | Question 5 Answer: C |
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