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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Practice Management | 10-15% | - Patient responsibility calculations - Accounts receivable management - Patient registration and demographics - Insurance verification processes - Collections and payment posting |
| Billing Compliance and Regulations | 10-15% | - Documentation compliance - Appeal and denial management - HIPAA privacy and security requirements - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics |
| Insurance and Reimbursement | 20-25% | - Claims submission and processing - Fee schedules and reimbursement methodologies - Coordination of benefits - Workers' compensation and no-fault billing - Commercial insurance policies - Government payers (Medicare, Medicaid, TRICARE) |
| CPT Coding | 20-25% | - Category II and III codes - Surgical procedure codes - Evaluation and Management (E/M) codes - CPT code categories and structure - Modifiers and their appropriate use |
| ICD-10-CM Diagnosis Coding | 15-20% | - ICD-10-CM structure and conventions - Secondary diagnosis coding - Chapter-specific guidelines - Principal diagnosis selection - Code accuracy and specificity |
| Healthcare Billing Fundamentals | 15-20% | - Medical terminology basics - Healthcare documentation principles - Anatomy and physiology for billers - Revenue cycle overview |
AAPC Certified Professional Biller (CPB) Sample Questions:
Question 1
Birthday rule determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
A. FALSE
B. TRUE
Question 2
Which of the following suffixes refers to in?
A. ex
B. en
C. red
D. extra
Question 3
Who is the person who prepares and reviews claims for accuracy to ensure prompt payment?
A. Independent Contractor
B. Health Insurance Specialist
C. Healthcare Provider
Question 4
What does GEM stand for?
A. Group Enrollment Management
B. General Equivalency Mapping
C. General Enrollment Management
D. Geographic Equivalency Mapping
Question 5
Which professional association was founded to improve the quality of medical records and current advances toward an electronic and global environment including the implementation of ICD10CM
A. An association of independent Blue Cross Blue Shield plans
B. Joint venture between Blue Cross and Blue shield where the corporations shared one building and computer services but maintained separate corporate identities
C. American Health Information Management Association (AHIMA)
D. American Academy of Professional Coders (AAPC)
Solutions:
| Question 1 Answer: B | Question 2 Answer: B | Question 3 Answer: B | Question 4 Answer: B | Question 5 Answer: C |
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