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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Insurance and Reimbursement | 20-25% | - Government payers (Medicare, Medicaid, TRICARE) - Fee schedules and reimbursement methodologies - Coordination of benefits - Claims submission and processing - Workers' compensation and no-fault billing - Commercial insurance policies |
| Topic 2: Healthcare Billing Fundamentals | 15-20% | - Medical terminology basics - Anatomy and physiology for billers - Healthcare documentation principles - Revenue cycle overview |
| Topic 3: CPT Coding | 20-25% | - Modifiers and their appropriate use - Surgical procedure codes - CPT code categories and structure - Category II and III codes - Evaluation and Management (E/M) codes |
| Topic 4: Billing Compliance and Regulations | 10-15% | - Documentation compliance - HIPAA privacy and security requirements - Fraud, waste, and abuse prevention - Appeal and denial management - Stark Law and Anti-Kickback Statute basics |
| Topic 5: Practice Management | 10-15% | - Patient responsibility calculations - Accounts receivable management - Patient registration and demographics - Insurance verification processes - Collections and payment posting |
| Topic 6: ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - Chapter-specific guidelines - Principal diagnosis selection - Secondary diagnosis coding - ICD-10-CM structure and conventions |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. What does it mean by cry?
A) warm
B) hot
C) cool
D) cold
2. The medical prefix "ab-" means:
A) extremities, top
B) toward
C) abdomen
D) away from
3. What does it mean by graphy?
A) process of recording
B) process of publishing
4. GPWW stands for Group Practice Without Walls.
A) TRUE
B) FALSE
5. What does BSR stand for?
A) Beneficiary Standards Representative
B) Black Shield Representative
C) Beneficiary Services Representative
D) Blue Shield Representative
Solutions:
| Question # 1 Answer: D | Question # 2 Answer: D | Question # 3 Answer: A | Question # 4 Answer: A | Question # 5 Answer: C |
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