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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Billing Compliance and Regulations | 10-15% | - Stark Law and Anti-Kickback Statute basics - Appeal and denial management - HIPAA privacy and security requirements - Fraud, waste, and abuse prevention - Documentation compliance |
| Practice Management | 10-15% | - Patient registration and demographics - Collections and payment posting - Patient responsibility calculations - Accounts receivable management - Insurance verification processes |
| Insurance and Reimbursement | 20-25% | - Workers' compensation and no-fault billing - Coordination of benefits - Claims submission and processing - Government payers (Medicare, Medicaid, TRICARE) - Commercial insurance policies - Fee schedules and reimbursement methodologies |
| ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - Chapter-specific guidelines - Principal diagnosis selection - ICD-10-CM structure and conventions - Secondary diagnosis coding |
| CPT Coding | 20-25% | - Surgical procedure codes - Evaluation and Management (E/M) codes - Modifiers and their appropriate use - Category II and III codes - CPT code categories and structure |
| Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Medical terminology basics - Anatomy and physiology for billers - Healthcare documentation principles |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. Which is a professional member of the healthcare team who provides services or supplies to the insured?
A) Healthcare Provider
B) Independent Contractor
C) Health Insurance Specialist
2. Blue Shield (BS) __________
A) began as a resolution passed by the house of Delegates at an American Medical Association meetings in 1938; incorporates a concept of voluntary health insurance that encourages physicians to corporate with prepaid health plans.
B) began as a resolution passed by the house of Delegates at an American Medical Association meetings in 1941; incorporates a concept of voluntary health insurance that encourages physicians to corporate with prepaid health plans.
C) began as a resolution passed by the house of Delegates at an American Medical Association meetings in 1939; incorporates a concept of voluntary health insurance that encourages physicians to corporate with prepaid health plans.
D) began as a resolution passed by the house of Delegates at an American Medical Association meetings in 1940; incorporates a concept of voluntary health insurance that encourages physicians to corporate with prepaid health plans.
3. What does CF stand for?
A) Civilian FactorAffairs
B) Competitive Factor
C) Conversion Factor
D) Clinical Factor
4. CAC (Choose two.)
A) Common Access Card
B) Computer Assisted Coding
C) Computerized Axial Tomography
D) Certified Coding Specialist
5. CRI
A) CHAMPUS Reform Initiative
B) Debt Collection Assistance Officer
C) Customized SubCapitation Plan
D) Computed Tomography
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: A | Question # 3 Answer: C | Question # 4 Answer: A,B | Question # 5 Answer: A |
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