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AAPC CPB Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Compliance and Regulations | - Fraud and abuse prevention - HIPAA and patient privacy rules - Billing compliance standards |
| Insurance Processing and Payer Rules | - Medicare and Medicaid guidelines - Coordination of benefits (COB) - Private insurance policies and contracts |
| Revenue Cycle Management | - Accounts receivable follow-up - Payment posting and reconciliation - Claims denial and rejection management |
| Medical Billing Fundamentals | - Healthcare reimbursement systems - Medical billing workflow and revenue cycle - Insurance types and payer structures |
| Coding and Claim Submission Basics | - Use of modifiers and coding compliance - Claims submission processes - ICD-10-CM, CPT, and HCPCS overview |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. Capitation
A) Provider accepts preestablished payments for providing healthcare services to enrollees over a period of time (usually one month)
B) Provider accepts preestablished payments for providing healthcare services to enrollees over a period of time (usually one quarter)
C) Provider accepts preestablished payments for providing healthcare services to enrollees over a period of time (usually 6 months)
D) Provider accepts preestablished payments for providing healthcare services to enrollees over a period of time (usually one year)
2. Which is the universal claim form used by physicians offices?
A) Health Insurance Claim
B) Explanation of Benefits
C) Hold Harmless Clause
D) Centers of Medicare and Medicaid Services150 (CMS1500)
3. What document is used to transfer patient financial responsibility after insurance adjudication?
A) Prior Authorization
B) Patient Statement
C) CMS-1500
D) UB-04
4. iasis
A) short
B) eyelid
C) two
D) condition
5. The medical prefix "hyper-" means:
A) uterus, womb
B) above, excessive
C) condition
Solutions:
| Question # 1 Answer: D | Question # 2 Answer: D | Question # 3 Answer: B | Question # 4 Answer: D | Question # 5 Answer: B |
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