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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Billing Compliance and Regulations | 10-15% | - 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 Management | 10-15% | - Insurance verification processes - Collections and payment posting - Patient registration and demographics - Patient responsibility calculations - Accounts receivable management |
| Topic 3: Insurance and Reimbursement | 20-25% | - 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 Coding | 15-20% | - Secondary diagnosis coding - ICD-10-CM structure and conventions - Code accuracy and specificity - Chapter-specific guidelines - Principal diagnosis selection |
| Topic 5: CPT Coding | 20-25% | - 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 Fundamentals | 15-20% | - 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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