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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Claims and Billing | 14% | - Denials, appeals, corrections - Timely filing rules - Electronic claims, clearinghouses - Claim submission, tracking, follow-up |
| Topic 2: Types of Insurance | 21% | - Commercial payers - Medicare, Medigap, Medicaid - Third-party liability - Managed care plans - TRICARE/CHAMPUS, Workers' compensation |
| Topic 3: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity - Code validation, modifiers |
| Topic 4: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Privacy, security, transaction standards - Medical record retention - Compliance programs |
| Topic 5: Reimbursement and Collections | 14% | - Patient statements, collections - Payment posting, adjustments - Refunds, payment plans, write-offs - Accounts receivable management |
| Topic 6: Billing Regulations | 13% | - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages - Payer payment policies |
| Topic 7: Case Analysis | 17% | - End-to-end billing scenarios - Adjudication and resolution - Eligibility verification |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. DMERC
A) Disproportionate share hospital (adjustment)
B) Diagnosis related groups
C) Department of Defense
D) Durable Medical Equipment regional carriers
2. What does it mean by adip?
A) thin
B) fat
3. CLIA
A) UB04 Claim used by institutional and other selected providers to bill payers
B) Clinical Laboratory Improvement Act
C) Competitive Medical Plan
D) Centers of Medicare and Medicaid Services
4. What does CCS stand for?
A) Certified Coding Services
B) Certified Coding Specialist
C) Certified Coding Standards
5. American Association of Medical Assistants (AAMA) enables medical assisting professionals to enhance and demonstrate the knowledge, skills, and professionalism required by employers and patients; as well as protect medical assistants' right to practice.
A) FALSE
B) TRUE
Solutions:
| Question # 1 Answer: D | Question # 2 Answer: B | Question # 3 Answer: B | Question # 4 Answer: B | Question # 5 Answer: B |
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