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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: CPT Coding | 20-25% | - Category II and III codes - Surgical procedure codes - Evaluation and Management (E/M) codes - Modifiers and their appropriate use - CPT code categories and structure |
| Topic 2: Billing Compliance and Regulations | 10-15% | - Documentation compliance - Fraud, waste, and abuse prevention - Appeal and denial management - HIPAA privacy and security requirements - Stark Law and Anti-Kickback Statute basics |
| Topic 3: ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - Principal diagnosis selection - Secondary diagnosis coding - Chapter-specific guidelines - ICD-10-CM structure and conventions |
| Topic 4: Insurance and Reimbursement | 20-25% | - Fee schedules and reimbursement methodologies - Workers' compensation and no-fault billing - Coordination of benefits - Government payers (Medicare, Medicaid, TRICARE) - Claims submission and processing - Commercial insurance policies |
| Topic 5: Healthcare Billing Fundamentals | 15-20% | - Healthcare documentation principles - Revenue cycle overview - Anatomy and physiology for billers - Medical terminology basics |
| Topic 6: Practice Management | 10-15% | - Collections and payment posting - Patient responsibility calculations - Patient registration and demographics - Insurance verification processes - Accounts receivable management |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. What is the primary purpose of a compliance program in a medical billing office?
A) Prevent fraud, waste, and abuse
B) Reduce staffing needs
C) Speed up claim payments
D) Increase reimbursement
2. in
A) in, into, not
B) between
C) within, into
3. Billing entity is the legal business name of the provider's practice.
A) TRUE
B) FALSE
4. CDHP stands for Consumer Directed Health Plan.
A) TRUE
B) FALSE
5. Blue Cross Blue Shield (BCBS) is joint venture between Blue Cross and Blue Shield where the corporation shared one building and computer.
A) TRUE
B) FALSE
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: A | Question # 3 Answer: A | Question # 4 Answer: A | Question # 5 Answer: A |
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