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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
| Topic 2: HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Medical record retention - Compliance programs - Fraud, abuse, False Claims Act |
| Topic 3: Types of Insurance | 21% | - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Commercial payers - Third-party liability |
| Topic 4: Billing Regulations | 13% | - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Payer payment policies - Incident-to billing, global packages |
| Topic 5: Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Topic 6: Claims and Billing | 14% | - Denials, appeals, corrections - Claim submission, tracking, follow-up - Electronic claims, clearinghouses - Timely filing rules |
| Topic 7: Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Payment posting, adjustments - Accounts receivable management - Patient statements, collections |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. bronch
A) neck, cervix
B) head
C) heart
D) bronchial tube
2. Capitation
A) Provider accepts preestablished payments for providing healthcare services to enrollees over a period of time (usually one year)
B) Provider accepts preestablished payments for providing healthcare services to enrollees over a period of time (usually one month)
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 quarter)
3. What is accreditation?
A) Involuntary Process that a healthcare facility or organization (e.g. hospital or managed care plan) undergoes to demonstrate that it has met standards beyond those required by law.
B) Voluntary Process that a healthcare facility or organization (e.g. hospital or managed care plan) undergoes to demonstrate that it has met standards beyond those required by law.
4. iasis
A) short
B) two
C) eyelid
D) condition
5. What is the main purpose of an audit in medical billing?
A) Ensure billing accuracy and compliance
B) Increase workload
C) Speed up reimbursements
D) Punish billers
Solutions:
| Question # 1 Answer: D | Question # 2 Answer: A | Question # 3 Answer: B | Question # 4 Answer: D | Question # 5 Answer: A |
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