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AAPC CPB Exam Syllabus Topics:

SectionWeightObjectives
Topic 1: Billing Compliance and Regulations10-15%- Appeal and denial management
- Stark Law and Anti-Kickback Statute basics
- Fraud, waste, and abuse prevention
- HIPAA privacy and security requirements
- Documentation compliance
Topic 2: Practice Management10-15%- Insurance verification processes
- Collections and payment posting
- Patient registration and demographics
- Patient responsibility calculations
- Accounts receivable management
Topic 3: Insurance and Reimbursement20-25%- Claims submission and processing
- Commercial insurance policies
- Government payers (Medicare, Medicaid, TRICARE)
- Workers' compensation and no-fault billing
- Coordination of benefits
- Fee schedules and reimbursement methodologies
Topic 4: ICD-10-CM Diagnosis Coding15-20%- Secondary diagnosis coding
- ICD-10-CM structure and conventions
- Code accuracy and specificity
- Chapter-specific guidelines
- Principal diagnosis selection
Topic 5: CPT Coding20-25%- Modifiers and their appropriate use
- Evaluation and Management (E/M) codes
- Category II and III codes
- CPT code categories and structure
- Surgical procedure codes
Topic 6: Healthcare Billing Fundamentals15-20%- Healthcare documentation principles
- Anatomy and physiology for billers
- Medical terminology basics
- Revenue cycle overview

AAPC Certified Professional Biller (CPB) Sample Questions:

1. Amendment to the HMO Act of 1973 is legislation that allowed federally qualified HMOs to permit members to occasionally use non HMO physicians and be partially reimbursed.

A) TRUE
B) FALSE


2. What does it mean by derm and dermat?

A) nail
B) blood
C) skin
D) bones


3. BCAC stands for Beneficiary Counseling and Assistance Coordinator.

A) TRUE
B) FALSE


4. CHAMPUS stands for Civilian Health and Medical Program of Veterans Affairs.

A) TRUE
B) FALSE


5. DRG

A) Diagnosis related groups
B) Diagnostic and statistical manual
C) Disproportionate share hospital (adjustment)
D) (California) Employment Development Department


Solutions:

Question # 1
Answer: A
Question # 2
Answer: C
Question # 3
Answer: A
Question # 4
Answer: A
Question # 5
Answer: A

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