Paaed the CPB exam yesterday! There are some new case study questions in the exam though. So you may need to get revising. Good luck!

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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: CPT Coding | 20-25% | - Modifiers and their appropriate use - Category II and III codes - CPT code categories and structure - Surgical procedure codes - Evaluation and Management (E/M) codes |
| Topic 2: Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Medical terminology basics - Healthcare documentation principles - Anatomy and physiology for billers |
| Topic 3: ICD-10-CM Diagnosis Coding | 15-20% | - ICD-10-CM structure and conventions - Principal diagnosis selection - Secondary diagnosis coding - Chapter-specific guidelines - Code accuracy and specificity |
| Topic 4: Insurance and Reimbursement | 20-25% | - Commercial insurance policies - Claims submission and processing - Government payers (Medicare, Medicaid, TRICARE) - Fee schedules and reimbursement methodologies - Coordination of benefits - Workers' compensation and no-fault billing |
| Topic 5: Practice Management | 10-15% | - Collections and payment posting - Accounts receivable management - Insurance verification processes - Patient responsibility calculations - Patient registration and demographics |
| Topic 6: Billing Compliance and Regulations | 10-15% | - Fraud, waste, and abuse prevention - Appeal and denial management - HIPAA privacy and security requirements - Stark Law and Anti-Kickback Statute basics - Documentation compliance |
1. What does GEM stand for?
A) General Equivalency Mapping
B) General Enrollment Management
C) Geographic Equivalency Mapping
D) Group Enrollment Management
2. What does CDHS stand for?
A) Connecticut Department of Health Services
B) California Department of Health Services
C) Colorado Department of Health Services
3. The medical prefixes "hypo-" or "hyp-" mean:
A) below, under
B) uterus, womb
C) condition
D) above, excessive
4. de
A) skin
B) right
C) half
D) lack of, down
5. blephar
A) short
B) eyelid
C) slow
D) condition
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: B | Question # 3 Answer: A | Question # 4 Answer: D | Question # 5 Answer: B |
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Certified Professional Biller (CPB)
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