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AAPC CPB Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Revenue Cycle Management | - Claims denial and rejection management - Payment posting and reconciliation - Accounts receivable follow-up |
| Medical Billing Fundamentals | - Healthcare reimbursement systems - Insurance types and payer structures - Medical billing workflow and revenue cycle |
| Coding and Claim Submission Basics | - ICD-10-CM, CPT, and HCPCS overview - Claims submission processes - Use of modifiers and coding compliance |
| Compliance and Regulations | - Billing compliance standards - HIPAA and patient privacy rules - Fraud and abuse prevention |
| Insurance Processing and Payer Rules | - Private insurance policies and contracts - Coordination of benefits (COB) - Medicare and Medicaid guidelines |
AAPC Certified Professional Biller (CPB) Sample Questions:
Adjudication
- A. Also called adverse reaction; the appearance of a pathologic condition due to ingestion r exposure to a chemical substance properly administered or taken.
- 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. Document that acknowledges patient responsibility for payment if Medicare denies the claim
Correct Answer: B 🗳️
What does AHA stand for?
- A. American Healthcare Association
- B. American Hostel Association
- C. American Hospital Association
- D. American Hospitality Association
Correct Answer: C 🗳️
CMS1500
- A. Clinical nurse specialist
- B. Coordination of Benefits
- C. Consolidated Omnibus Budget Reconciliation Act of 1985
- D. Insurance claim used by noninstitutional providers and supplier to bill payers
Correct Answer: D 🗳️
Case management is development of patient care plans to coordinate and provide care for complicated cases in a cost effective manner.
- A. FALSE
- B. TRUE
Correct Answer: B 🗳️
Advance Beneficiary Notice (ABN) is document that acknowledges patient responsibility for payment if Medicare denies the claim.
- A. FALSE
- B. TRUE
Correct Answer: B 🗳️
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