Exam Name: Certified Professional Biller (CPB)
Certification Provider: AAPC
Corresponding Certification: AAPC Certification
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AAPC CPB Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Topic 1: Insurance Processing and Payer Rules | - Medicare and Medicaid guidelines - Coordination of benefits (COB) - Private insurance policies and contracts |
| Topic 2: Medical Billing Fundamentals | - Medical billing workflow and revenue cycle - Insurance types and payer structures - Healthcare reimbursement systems |
| Topic 3: Compliance and Regulations | - Fraud and abuse prevention - Billing compliance standards - HIPAA and patient privacy rules |
| Topic 4: Coding and Claim Submission Basics | - ICD-10-CM, CPT, and HCPCS overview - Claims submission processes - Use of modifiers and coding compliance |
| Topic 5: Revenue Cycle Management | - Payment posting and reconciliation - Accounts receivable follow-up - Claims denial and rejection management |
AAPC Certified Professional Biller (CPB) Sample Questions:
Benefit period (Medicare) __________
- A. begins with the first day of hospitalization and ends when the patient has been out of the hospital for 90 consecutive days.
- B. begins with the first day of hospitalization and ends when the patient has been out of the hospital for 120 consecutive days.
- C. begins with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days.
- D. begins with the first day of hospitalization and ends when the patient has been out of the hospital for 30 consecutive days.
Correct Answer: C 🗳️
DEERS
- A. Durable Medical Equipment regional carriers
- B. Defense Enrollment Eligibility Reporting System
- C. Durable Medical Equipment
- D. Durable Medical Equipment, Prosthetic and Orthotic Supplies
Correct Answer: B 🗳️
DRG
- A. Diagnostic and statistical manual
- B. (California) Employment Development Department
- C. Diagnosis related groups
- D. Disproportionate share hospital (adjustment)
Correct Answer: C 🗳️
Accounts Receivable Management
- A. Payment correction resulting in additional payment(s) to the provider.
- B. Voluntary Process that a healthcare facility or organization (e.g. hospital or managed care plan) undergoes to demonstrate that it has met standards beyond those required by law.
- C. Judicial dispute resolution process in which an appeals board makes a final determination.
- D. Assists providers in the collection of appropriate reimbursement for services rendered; include functions such as insurance verification/eligibility and preauthorization of services
Correct Answer: D 🗳️
FECA stands for Federal Employment Compensation Act.
- A. FALSE
- B. TRUE
Correct Answer: B 🗳️
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