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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management |
| Topic 2: Types of Insurance | 21% | - Third-party liability - Commercial payers - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Managed care plans |
| Topic 3: HIPAA and Compliance | 9% | - Medical record retention - Fraud, abuse, False Claims Act - Compliance programs - Privacy, security, transaction standards |
| Topic 4: Billing Regulations | 13% | - Incident-to billing, global packages - Payer payment policies - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion |
| Topic 5: Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| Topic 6: Claims and Billing | 14% | - Denials, appeals, corrections - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Timely filing rules |
| Topic 7: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity - Code validation, modifiers |
AAPC Certified Professional Biller (CPB) Sample Questions:
Question 1
CMS
A. Clinical nurse specialist
B. Insurance claim used by noninstitutional providers and supplier to bill payers
C. UB04 Claim used by institutional and other selected providers to bill payers
D. Centers of Medicare and Medicaid Services
Question 2
Which part of the body does genit refer to?
A. intestine
B. stomach
C. genitals
D. tongue
Question 3
What does it mean by graph?
A. instrument for hearing
B. process of recording
C. instrument for speaking
D. instrument for reading
Question 4
Preauthorization is an authorization that must be received from a payer before treatment by a specialist will be covered.
A. FALSE
B. TRUE
Question 5
What does HA stand for?
A. Home Assessment
B. Health Affairs
C. Healthcare Affairs
D. Healthcare Assessment
Solutions:
| Question 1 Answer: D | Question 2 Answer: C | Question 3 Answer: D | Question 4 Answer: B | Question 5 Answer: B |
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Armstrong 
Jonas 
Clare 
Marico 
Thera 
Arvin 
May 
Atwood 
Eden 
Edwiin 
Drew 
Blair 
Eugene 
Taylor 
