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AAPC CPB Exam Syllabus Topics:

SectionWeightObjectives
Insurance and Reimbursement20-25%- Workers' compensation and no-fault billing
- Government payers (Medicare, Medicaid, TRICARE)
- Coordination of benefits
- Commercial insurance policies
- Fee schedules and reimbursement methodologies
- Claims submission and processing
ICD-10-CM Diagnosis Coding15-20%- Principal diagnosis selection
- Code accuracy and specificity
- Secondary diagnosis coding
- ICD-10-CM structure and conventions
- Chapter-specific guidelines
Practice Management10-15%- Patient registration and demographics
- Insurance verification processes
- Accounts receivable management
- Patient responsibility calculations
- Collections and payment posting
Healthcare Billing Fundamentals15-20%- Anatomy and physiology for billers
- Revenue cycle overview
- Healthcare documentation principles
- Medical terminology basics
CPT Coding20-25%- Modifiers and their appropriate use
- Evaluation and Management (E/M) codes
- Category II and III codes
- Surgical procedure codes
- CPT code categories and structure
Billing Compliance and Regulations10-15%- Fraud, waste, and abuse prevention
- HIPAA privacy and security requirements
- Documentation compliance
- Appeal and denial management
- Stark Law and Anti-Kickback Statute basics

AAPC Certified Professional Biller (CPB) Sample Questions:

1. ERA

A) Employee Retirements income security Act of 1974
B) False Claims Act
C) First Look Analysis for Hospital Outlier Monitoring
D) Electronic Remittance Advice


2. DOD

A) Diagnostic and statistical manual
B) Department of Defense
C) Disproportionate share hospital (adjustment)
D) Diagnosis related groups


3. Catastrophic cap benefit protects TRICARE beneficiaries form devastating financial loss due to serious illness or long-term treatment by establishing limits over which payments is not required.

A) FALSE
B) TRUE


4. Which is the universal claim form used by physicians offices?

A) Hold Harmless Clause
B) Explanation of Benefits
C) Centers of Medicare and Medicaid Services150 (CMS1500)
D) Health Insurance Claim


5. What does it mean by benign?

A) cancerous
B) not cancerous


Solutions:

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

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