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AAPC CPB Exam Syllabus Topics:

SectionWeightObjectives
Topic 1: Case Analysis17%- Adjudication and resolution
- End-to-end billing scenarios
- Eligibility verification
Topic 2: HIPAA and Compliance9%- Privacy, security, transaction standards
- Medical record retention
- Compliance programs
- Fraud, abuse, False Claims Act
Topic 3: Types of Insurance21%- Medicare, Medigap, Medicaid
- TRICARE/CHAMPUS, Workers' compensation
- Managed care plans
- Commercial payers
- Third-party liability
Topic 4: Billing Regulations13%- CMS-1500, UB-04 completion
- ACOs, NCCI, LCDs, NCDs
- Payer payment policies
- Incident-to billing, global packages
Topic 5: Coding Concepts for Billers12%- Code validation, modifiers
- ICD-10-CM, CPT®, HCPCS Level II
- Medical necessity
Topic 6: Claims and Billing14%- Denials, appeals, corrections
- Claim submission, tracking, follow-up
- Electronic claims, clearinghouses
- Timely filing rules
Topic 7: Reimbursement and Collections14%- 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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