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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Coding Concepts for Billers | 12% | - Code validation, modifiers - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II |
| Topic 2: Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Payment posting, adjustments - Patient statements, collections - Accounts receivable management |
| Topic 3: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Medical record retention - Privacy, security, transaction standards - Compliance programs |
| Topic 4: Types of Insurance | 21% | - Commercial payers - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Medicare, Medigap, Medicaid |
| Topic 5: Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Payer payment policies - Incident-to billing, global packages |
| Topic 6: Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
| Topic 7: Claims and Billing | 14% | - Electronic claims, clearinghouses - Denials, appeals, corrections - Timely filing rules - Claim submission, tracking, follow-up |
AAPC Certified Professional Biller (CPB) Sample Questions:
Question 1
What are Category II codes?
A. Temporary codes for data collection purposes that are assigned an alphanumeric identifier with a letter in the last field (e.g., 0001T) these codes are located after the Medicine section, and will be archived after five years unless accepted for placement within Category I sections of CPT.
B. Optional performance measurement tracking codes that are assigned an alphanumeric identifier with a letter in the last field (e,g.,1234A); these codes will be located after the medicine section; their use is optional.
C. Procedures/ services identified by a five digit CPT code and descriptor nomenclature; these codes are traditionally associated with CPT and organized within six sections.
Question 2
CA refers to Cancer or Carcinoma.
A. FALSE
B. TRUE
Question 3
HCRA stands for Healthcare Reimbursement Account.
A. FALSE
B. TRUE
Question 4
EQRO
A. External Quality Review Organization
B. Electronic Remittance Advice
C. First Look Analysis for Hospital Outlier Monitoring
D. Employee Retirements income security Act of 1974
Question 5
CHAMPUS stands for Civilian Health and Medical Program of Veterans Affairs.
A. FALSE
B. TRUE
Solutions:
| Question 1 Answer: B | Question 2 Answer: B | Question 3 Answer: B | Question 4 Answer: A | Question 5 Answer: B |
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