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AAPC CPB Exam Syllabus Topics:

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

AAPC Certified Professional Biller (CPB) Sample Questions:

1. Which document communicates to the payer that the provider is requesting reimbursement?

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


2. in

A) in, into, not
B) between
C) within, into


3. anti

A) condition
B) joint
C) against


4. Care plan oversight services cover the physician's time supervising a complex and multidisciplinary care treatment program for specific patient who is under the care of a home health agency, hospice, or nursing facility.

A) TRUE
B) FALSE


5. Which term means the patient is not responsible for paying for what the insurance plan denies?

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


Solutions:

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

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