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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Claims and Billing | 14% | - Timely filing rules - Claim submission, tracking, follow-up - Denials, appeals, corrections - Electronic claims, clearinghouses |
| Topic 2: Billing Regulations | 13% | - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages - Payer payment policies |
| Topic 3: HIPAA and Compliance | 9% | - Medical record retention - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Compliance programs |
| Topic 4: Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Commercial payers - Third-party liability - Managed care plans - Medicare, Medigap, Medicaid |
| Topic 5: Case Analysis | 17% | - Eligibility verification - Adjudication and resolution - End-to-end billing scenarios |
| Topic 6: Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Patient statements, collections - Accounts receivable management - Payment posting, adjustments |
| 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:
1. HPSA stands for Health Personnel Shortage Area.
A) TRUE
B) FALSE
2. What does it mean by dis?
A) combination
B) separation
3. What is Ambulatory Surgical Center Payment Rate?
A) Determined amount for which ASC services are reimbursed, at 80 percent after adjustment for regional wage variations.
B) Determined amount for which ASC services are reimbursed, at 80 percent before adjustment for regional wage variations.
C) Predetermined amount for which ASC services are reimbursed, at 80 percent before adjustment for regional wage variations.
D) Predetermined amount for which ASC services are reimbursed, at 80 percent after adjustment for regional wage variations.
4. What is accreditation?
A) 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.
B) 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.
5. Which part of the body does gloss refer to?
A) cheek
B) teeth
C) tongue
D) lips
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: B | Question # 3 Answer: D | Question # 4 Answer: A | Question # 5 Answer: C |


