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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages - Payer payment policies - CMS-1500, UB-04 completion |
| Topic 2: HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Medical record retention - Compliance programs - Fraud, abuse, False Claims Act |
| Topic 3: Types of Insurance | 21% | - Medicare, Medigap, Medicaid - Third-party liability - TRICARE/CHAMPUS, Workers' compensation - Commercial payers - Managed care plans |
| Topic 4: Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Payment posting, adjustments - Accounts receivable management - Patient statements, collections |
| Topic 5: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers - Medical necessity |
| Topic 6: Claims and Billing | 14% | - Claim submission, tracking, follow-up - Denials, appeals, corrections - Timely filing rules - Electronic claims, clearinghouses |
| Topic 7: Case Analysis | 17% | - Eligibility verification - End-to-end billing scenarios - Adjudication and resolution |
AAPC Certified Professional Biller (CPB) Sample Questions:
HAVEN stands for Home Assessment Validation and Entry.
- A. FALSE
- B. TRUE
Correct Answer: B 🗳️
The medical prefix "dys-" means:
- A. excision, removal
- B. blood condition
- C. vomiting
- D. bad, painful
Correct Answer: D 🗳️
GCPI stands for Geographic Cost Practice Index.
- A. FALSE
- B. TRUE
Correct Answer: B 🗳️
Which professional association was founded to elevate the standards of medical coding by providing certification, ongoing education, networking, and recognition for coders?
- A. Joint venture between Blue Cross and Blue shield where the corporations shared one building and computer services but maintained separate corporate identities
- B. An association of independent Blue Cross Blue Shield plans
- C. American Health Information Management Association (AHIMA)
- D. American Academy of Professional Coders (AAPC)
Correct Answer: D 🗳️
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