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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Types of Insurance | 21% | - Third-party liability - Commercial payers - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Managed care plans |
| Topic 2: Case Analysis | 17% | - Eligibility verification - Adjudication and resolution - End-to-end billing scenarios |
| Topic 3: Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Payer payment policies - CMS-1500, UB-04 completion - Incident-to billing, global packages |
| Topic 4: HIPAA and Compliance | 9% | - Medical record retention - Compliance programs - Fraud, abuse, False Claims Act - Privacy, security, transaction standards |
| Topic 5: Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Accounts receivable management - Patient statements, collections - Payment posting, adjustments |
| Topic 6: Claims and Billing | 14% | - Timely filing rules - Claim submission, tracking, follow-up - Denials, appeals, corrections - Electronic claims, clearinghouses |
| Topic 7: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers - Medical necessity |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. What does it mean by graphy?
A) process of publishing
B) process of recording
2. FATHOM
A) False Claims Act
B) First Look Analysis for Hospital Outlier Monitoring
C) Fair Debt Collection Practices Act
D) Federal Employment Compensation Act
3. Who is the person who prepares and reviews claims for accuracy to ensure prompt payment?
A) Healthcare Provider
B) Health Insurance Specialist
C) Independent Contractor
4. HCF stands for Healthcare Finder.
A) TRUE
B) FALSE
5. Billing entity is the legal business name of the provider's practice.
A) TRUE
B) FALSE
Solutions:
| Question # 1 Answer: B | Question # 2 Answer: B | Question # 3 Answer: B | Question # 4 Answer: A | Question # 5 Answer: A |
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