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AAPC CPB Exam Syllabus Topics:

SectionWeightObjectives
Topic 1: Healthcare Billing Fundamentals15-20%- Healthcare documentation principles
- Anatomy and physiology for billers
- Medical terminology basics
- Revenue cycle overview
Topic 2: Insurance and Reimbursement20-25%- Government payers (Medicare, Medicaid, TRICARE)
- Claims submission and processing
- Commercial insurance policies
- Workers' compensation and no-fault billing
- Coordination of benefits
- Fee schedules and reimbursement methodologies
Topic 3: Billing Compliance and Regulations10-15%- HIPAA privacy and security requirements
- Appeal and denial management
- Stark Law and Anti-Kickback Statute basics
- Documentation compliance
- Fraud, waste, and abuse prevention
Topic 4: ICD-10-CM Diagnosis Coding15-20%- Secondary diagnosis coding
- ICD-10-CM structure and conventions
- Code accuracy and specificity
- Principal diagnosis selection
- Chapter-specific guidelines
Topic 5: Practice Management10-15%- Patient registration and demographics
- Collections and payment posting
- Patient responsibility calculations
- Insurance verification processes
- Accounts receivable management
Topic 6: CPT Coding20-25%- CPT code categories and structure
- Category II and III codes
- Evaluation and Management (E/M) codes
- Surgical procedure codes
- Modifiers and their appropriate use

AAPC Certified Professional Biller (CPB) Sample Questions:

1. What are black box edits?

A) Nonpublished code edits, which were discontinued in 2001.
B) Published code edits, which were discontinued in 2001.
C) Published code edits, which were discontinued in 2000.
D) Nonpublished code edits, which were discontinued in 2000.


2. abdomin

A) extremities, top
B) abdomen
C) toward


3. Case management services is a process by which an attending physician coordinates and supervises care provided to patient by other providers.

A) TRUE
B) FALSE


4. Which part of the body do gaster and gastr refer to?

A) stomach
B) tongue
C) genitals
D) intestine


5. Which amount is written off when a provider is contracted with an insurance company?

A) Copayment
B) Deductible
C) Contractual adjustment
D) Allowed amount


Solutions:

Question # 1
Answer: D
Question # 2
Answer: B
Question # 3
Answer: A
Question # 4
Answer: A
Question # 5
Answer: C

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