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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - Principal diagnosis selection - ICD-10-CM structure and conventions - Secondary diagnosis coding - Chapter-specific guidelines |
| Insurance and Reimbursement | 20-25% | - Claims submission and processing - Commercial insurance policies - Government payers (Medicare, Medicaid, TRICARE) - Coordination of benefits - Workers' compensation and no-fault billing - Fee schedules and reimbursement methodologies |
| Healthcare Billing Fundamentals | 15-20% | - Healthcare documentation principles - Revenue cycle overview - Anatomy and physiology for billers - Medical terminology basics |
| Billing Compliance and Regulations | 10-15% | - HIPAA privacy and security requirements - Stark Law and Anti-Kickback Statute basics - Documentation compliance - Appeal and denial management - Fraud, waste, and abuse prevention |
| CPT Coding | 20-25% | - Modifiers and their appropriate use - Evaluation and Management (E/M) codes - Surgical procedure codes - CPT code categories and structure - Category II and III codes |
| Practice Management | 10-15% | - Patient responsibility calculations - Insurance verification processes - Accounts receivable management - Patient registration and demographics - Collections and payment posting |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. DMERC
A) Durable Medical Equipment regional carriers
B) Disproportionate share hospital (adjustment)
C) Department of Defense
D) Diagnosis related groups
2. DMEPOS
A) Durable Medical Equipment regional carriers
B) Department of Defense
C) Durable Medical Equipment, Prosthetic and Orthotic Supplies
D) Diagnosis related groups
3. What is All Patient DiagnosisRelated Group (APDRG)?
A) 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.
B) 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.
4. CAC (Choose two.)
A) Common Access Card
B) Computer Assisted Coding
C) Computerized Axial Tomography
D) Certified Coding Specialist
5. Case mix includes the types and categories of patients treated by a healthcare provider.
A) FALSE
B) TRUE
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: C | Question # 3 Answer: A | Question # 4 Answer: A,B | Question # 5 Answer: B |




