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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Reimbursement and Collections | 14% | - Patient statements, collections - Accounts receivable management - Payment posting, adjustments - Refunds, payment plans, write-offs |
| Topic 2: Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Topic 3: HIPAA and Compliance | 9% | - Compliance programs - Medical record retention - Privacy, security, transaction standards - Fraud, abuse, False Claims Act |
| Topic 4: Billing Regulations | 13% | - Payer payment policies - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Incident-to billing, global packages |
| Topic 5: Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
| Topic 6: Types of Insurance | 21% | - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Third-party liability - Commercial payers |
| Topic 7: Claims and Billing | 14% | - Denials, appeals, corrections - Timely filing rules - Claim submission, tracking, follow-up - Electronic claims, clearinghouses |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. What does it mean by galact and lact?
A) milk
B) water
C) alcohol
2. The medical word root "eti" (or "eti/o") refers to:
A) outside
B) fiber
C) cause
D) out, away from
3. CPT
A) CHAMPUS Reform Initiative
B) Current Procedural Terminology
C) Computed Tomography
D) Customized SubCapitation Plan
4. EQRO
A) External Quality Review Organization
B) Employee Retirements income security Act of 1974
C) First Look Analysis for Hospital Outlier Monitoring
D) Electronic Remittance Advice
5. DRG
A) Diagnosis related groups
B) (California) Employment Development Department
C) Diagnostic and statistical manual
D) Disproportionate share hospital (adjustment)
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: C | Question # 3 Answer: B | Question # 4 Answer: A | Question # 5 Answer: A |


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