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AAPC CPB Exam Syllabus Topics:

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