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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Coding Concepts for Billers | 12% | - Code validation, modifiers - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II |
| HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Privacy, security, transaction standards - Medical record retention - Compliance programs |
| Billing Regulations | 13% | - CMS-1500, UB-04 completion - Payer payment policies - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages |
| Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
| Claims and Billing | 14% | - Claim submission, tracking, follow-up - Electronic claims, clearinghouses - Timely filing rules - Denials, appeals, corrections |
| Reimbursement and Collections | 14% | - Patient statements, collections - Payment posting, adjustments - Accounts receivable management - Refunds, payment plans, write-offs |
| Types of Insurance | 21% | - Third-party liability - Commercial payers - Managed care plans - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation |
AAPC Certified Professional Biller (CPB) Sample Questions:
Question 1
hemi
A. liver
B. above, excessive
C. below, under
D. half
Question 2
FEP stands for Federal Employee Program.
A. FALSE
B. TRUE
Question 3
The medical word root "hyster" or "hyster/o" refers to the:
A. uterus, womb
B. condition
C. pertaining to
Question 4
Which part of the body does cephal refer to?
A. head
B. heart
C. vagina
D. neck
Question 5
What should be done if an insurance company incorrectly denies a covered service?
A. Resubmit the same claim without changes
B. Write off the charge
C. Bill the patient immediately
D. File an appeal with supporting documentation
Solutions:
| Question 1 Answer: D | Question 2 Answer: B | Question 3 Answer: A | Question 4 Answer: A | Question 5 Answer: D |
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