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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Claims and Billing | 14% | - Electronic claims, clearinghouses - Timely filing rules - Claim submission, tracking, follow-up - Denials, appeals, corrections |
| Topic 2: Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| Topic 3: Types of Insurance | 21% | - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Medicare, Medigap, Medicaid - Managed care plans |
| Topic 4: Reimbursement and Collections | 14% | - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management - Payment posting, adjustments |
| Topic 5: HIPAA and Compliance | 9% | - Compliance programs - Fraud, abuse, False Claims Act - Privacy, security, transaction standards - Medical record retention |
| Topic 6: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity - Code validation, modifiers |
| Topic 7: Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Payer payment policies - CMS-1500, UB-04 completion - Incident-to billing, global packages |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. What are Category III codes?
A) Procedures/ services identified by a five digit CPT code and descriptor nomenclature; these codes are traditionally associated with CPT and organized within six sections.
B) Temporary codes for data collection purposes that are assigned an alphanumeric identifier with a letter in the last field (e.g., 0001T) these codes are located after the Medicine section, and will be archived after five years unless accepted for placement within Category I sections of CPT.
C) Optional performance measurement tracking codes that are field (e,g.,1234A); these codes will be located after the medicine section; their use is optional.
2. CHAMPUS stands for Civilian Health and Medical Program of Veterans Affairs.
A) FALSE
B) TRUE
3. What does it mean by adip?
A) fat
B) thin
4. FECA stands for Federal Employment Compensation Act.
A) FALSE
B) TRUE
5. Case management is development of patient care plans to coordinate and provide care for complicated cases in a cost effective manner.
A) FALSE
B) TRUE
Solutions:
| Question # 1 Answer: B | Question # 2 Answer: B | Question # 3 Answer: A | Question # 4 Answer: B | Question # 5 Answer: B |
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