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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Insurance and Reimbursement | 20-25% | - Workers' compensation and no-fault billing - Commercial insurance policies - Fee schedules and reimbursement methodologies - Claims submission and processing - Coordination of benefits - Government payers (Medicare, Medicaid, TRICARE) |
| Practice Management | 10-15% | - Collections and payment posting - Accounts receivable management - Patient responsibility calculations - Patient registration and demographics - Insurance verification processes |
| ICD-10-CM Diagnosis Coding | 15-20% | - Chapter-specific guidelines - Principal diagnosis selection - Code accuracy and specificity - Secondary diagnosis coding - ICD-10-CM structure and conventions |
| Billing Compliance and Regulations | 10-15% | - Appeal and denial management - Documentation compliance - HIPAA privacy and security requirements - Stark Law and Anti-Kickback Statute basics - Fraud, waste, and abuse prevention |
| CPT Coding | 20-25% | - Evaluation and Management (E/M) codes - Category II and III codes - Modifiers and their appropriate use - CPT code categories and structure - Surgical procedure codes |
| Healthcare Billing Fundamentals | 15-20% | - Anatomy and physiology for billers - Revenue cycle overview - Medical terminology basics - Healthcare documentation principles |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. What does HIPAA stand for?
A) Health Insurance portability and accountability Act of 1997
B) Health Insurance portability and accountability Act of 1994
C) Health Insurance portability and accountability Act of 1995
D) Health Insurance portability and accountability Act of 1996
2. What does the acronym COB stand for in medical billing?
A) Current Procedural Terminology
B) Coordination of Benefits
C) Consolidated Omnibus Budget Reconciliation Act of 1985
D) Certified Professional Coder
3. What does it mean by dis?
A) combination
B) separation
4. What does it mean by graphy?
A) process of publishing
B) process of recording
5. What does APC stand for?
A) Ambulatory Patient Classification
B) Advanced Patient Classification
C) Ambulatory Payment Classification
D) Advanced Payment Classification
Solutions:
| Question # 1 Answer: D | Question # 2 Answer: B | Question # 3 Answer: B | Question # 4 Answer: B | Question # 5 Answer: C |
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