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AAPC CPB Exam Syllabus Topics:

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

AAPC Certified Professional Biller (CPB) Sample Questions:

1. FEP stands for Federal Employee Program.

A) FALSE
B) TRUE


2. Which of the following suffixes refers to in?

A) extra
B) red
C) en
D) ex


3. What is the primary purpose of National Correct Coding Initiative (NCCI) edits?

A) Set reimbursement rates
B) Replace CPT guidelines
C) Identify unbundling and improper coding
D) Increase claim approvals


4. American Academy of Processional Coders (AAPC) is professional association established to provide a national certification and credentialing process, to support the national and local membership by providing educational products and opportunities to network, and to increase and promote national recognition and awareness of professional coding.

A) FALSE
B) TRUE


5. EDD

A) Employer group health plan
B) Electronic data interchange
C) (California) Employment Development Department
D) Electronic funds transfer


Solutions:

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

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