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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Claims and Billing | 14% | - Timely filing rules - Claim submission, tracking, follow-up - Electronic claims, clearinghouses - Denials, appeals, corrections |
| Topic 2: Types of Insurance | 21% | - Medicare, Medigap, Medicaid - Third-party liability - TRICARE/CHAMPUS, Workers' compensation - Commercial payers - Managed care plans |
| Topic 3: HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Compliance programs - Medical record retention |
| Topic 4: Reimbursement and Collections | 14% | - Patient statements, collections - Refunds, payment plans, write-offs - Payment posting, adjustments - Accounts receivable management |
| Topic 5: Billing Regulations | 13% | - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Payer payment policies - Incident-to billing, global packages |
| Topic 6: Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
| Topic 7: Case Analysis | 17% | - Eligibility verification - End-to-end billing scenarios - Adjudication and resolution |
AAPC Certified Professional Biller (CPB) Sample Questions:
Question 1
in
A. between
B. within, into
C. in, into, not
Question 2
ERA
A. Electronic Remittance Advice
B. First Look Analysis for Hospital Outlier Monitoring
C. False Claims Act
D. Employee Retirements income security Act of 1974
Question 3
A patient has Medicare as primary and a commercial plan as secondary. Which insurance should be billed first?
A. Medicaid
B. Commercial insurance
C. Secondary insurance
D. Medicare
Question 4
Which situation is considered billing fraud?
A. Appealing a denied claim
B. Billing for services not rendered
C. Late claim submission
D. Typographical error on a claim
Question 5
Breach of confidentiality is unauthorized release of patient information to third party.
A. TRUE
B. FALSE
Solutions:
| Question 1 Answer: C | Question 2 Answer: A | Question 3 Answer: D | Question 4 Answer: B | Question 5 Answer: A |
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