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AAPC CPB Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Topic 1: Insurance Processing and Payer Rules | - Medicare and Medicaid guidelines - Coordination of benefits (COB) - Private insurance policies and contracts |
| Topic 2: Medical Billing Fundamentals | - Medical billing workflow and revenue cycle - Insurance types and payer structures - Healthcare reimbursement systems |
| Topic 3: Compliance and Regulations | - Fraud and abuse prevention - Billing compliance standards - HIPAA and patient privacy rules |
| Topic 4: Coding and Claim Submission Basics | - ICD-10-CM, CPT, and HCPCS overview - Claims submission processes - Use of modifiers and coding compliance |
| Topic 5: Revenue Cycle Management | - Payment posting and reconciliation - Accounts receivable follow-up - Claims denial and rejection management |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. Benefit period (Medicare) __________
A) begins with the first day of hospitalization and ends when the patient has been out of the hospital for 90 consecutive days.
B) begins with the first day of hospitalization and ends when the patient has been out of the hospital for 120 consecutive days.
C) begins with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days.
D) begins with the first day of hospitalization and ends when the patient has been out of the hospital for 30 consecutive days.
2. DEERS
A) Durable Medical Equipment regional carriers
B) Defense Enrollment Eligibility Reporting System
C) Durable Medical Equipment
D) Durable Medical Equipment, Prosthetic and Orthotic Supplies
3. DRG
A) Diagnostic and statistical manual
B) (California) Employment Development Department
C) Diagnosis related groups
D) Disproportionate share hospital (adjustment)
4. Accounts Receivable Management
A) Payment correction resulting in additional payment(s) to the provider.
B) 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.
C) Judicial dispute resolution process in which an appeals board makes a final determination.
D) Assists providers in the collection of appropriate reimbursement for services rendered; include functions such as insurance verification/eligibility and preauthorization of services
5. FECA stands for Federal Employment Compensation Act.
A) FALSE
B) TRUE
Solutions:
| Question # 1 Answer: C | Question # 2 Answer: B | Question # 3 Answer: C | Question # 4 Answer: D | Question # 5 Answer: B |
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