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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:
1. in
A) between
B) within, into
C) in, into, not
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
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
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
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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