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AAPC CPB Exam Syllabus Topics:

SectionWeightObjectives
Topic 1: HIPAA and Compliance9%- Privacy, security, transaction standards
- Compliance programs
- Medical record retention
- Fraud, abuse, False Claims Act
Topic 2: Coding Concepts for Billers12%- Code validation, modifiers
- Medical necessity
- ICD-10-CM, CPT®, HCPCS Level II
Topic 3: Case Analysis17%- End-to-end billing scenarios
- Eligibility verification
- Adjudication and resolution
Topic 4: Reimbursement and Collections14%- Refunds, payment plans, write-offs
- Patient statements, collections
- Payment posting, adjustments
- Accounts receivable management
Topic 5: Types of Insurance21%- TRICARE/CHAMPUS, Workers' compensation
- Commercial payers
- Third-party liability
- Medicare, Medigap, Medicaid
- Managed care plans
Topic 6: Billing Regulations13%- CMS-1500, UB-04 completion
- ACOs, NCCI, LCDs, NCDs
- Payer payment policies
- Incident-to billing, global packages
Topic 7: Claims and Billing14%- Claim submission, tracking, follow-up
- Denials, appeals, corrections
- Electronic claims, clearinghouses
- Timely filing rules

AAPC Certified Professional Biller (CPB) Sample Questions:

1. Which of the following suffixes means two?

A) hemi
B) demi
C) bi


2. Breach of confidentiality is unauthorized release of patient information to third party.

A) TRUE
B) FALSE


3. CMS1450

A) Insurance claim used by noninstitutional providers and supplier to bill payers
B) UB04 Claim used by institutional and other selected providers to bill payers
C) clinical nurse specialist
D) Coordination of Benefits


4. What does CF stand for?

A) Civilian FactorAffairs
B) Clinical Factor
C) Conversion Factor
D) Competitive Factor


5. What does the acronym ERISA stand for?

A) First Look Analysis for Hospital Outlier Monitoring
B) False Claims Act
C) Employee Retirements Income Security Act of 1974
D) Fair Debt Collection Practices Act


Solutions:

Question # 1
Answer: C
Question # 2
Answer: A
Question # 3
Answer: B
Question # 4
Answer: C
Question # 5
Answer: C

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