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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:
Birthday rule determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
- A. FALSE
- B. TRUE
Correct Answer: B 🗳️
Which of the following suffixes refers to in?
- A. ex
- B. en
- C. red
- D. extra
Correct Answer: B 🗳️
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
Correct Answer: B 🗳️
What does GEM stand for?
- A. Group Enrollment Management
- B. General Equivalency Mapping
- C. General Enrollment Management
- D. Geographic Equivalency Mapping
Correct Answer: B 🗳️
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)
Correct Answer: C 🗳️
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