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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Types of Insurance | 21% | - Third-party liability - Medicare, Medigap, Medicaid - Managed care plans - Commercial payers - TRICARE/CHAMPUS, Workers' compensation |
| Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Patient statements, collections - Payment posting, adjustments - Accounts receivable management |
| HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Compliance programs - Medical record retention - Privacy, security, transaction standards |
| Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Payer payment policies - Incident-to billing, global packages - CMS-1500, UB-04 completion |
| Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
| Claims and Billing | 14% | - Timely filing rules - Electronic claims, clearinghouses - Denials, appeals, corrections - Claim submission, tracking, follow-up |
| Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. What is Ambulatory Surgical Center Payment Rate?
A) Predetermined amount for which ASC services are reimbursed, at 80 percent after adjustment for regional wage variations.
B) Predetermined amount for which ASC services are reimbursed, at 80 percent before adjustment for regional wage variations.
C) Determined amount for which ASC services are reimbursed, at 80 percent before adjustment for regional wage variations.
D) Determined amount for which ASC services are reimbursed, at 80 percent after adjustment for regional wage variations.
2. What does the acronym FR stand for?
A) Federal Register
B) General Enrollment Period
C) Flexible Spending Account
D) General Equivalency Mapping
3. GCPI stands for Geographic Cost Practice Index.
A) FALSE
B) TRUE
4. arthr
A) two
B) condition
C) joint
5. What does HIPAA stand for?
A) Health Insurance portability and accountability Act of 1997
B) Health Insurance portability and accountability Act of 1996
C) Health Insurance portability and accountability Act of 1994
D) Health Insurance portability and accountability Act of 1995
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: A | Question # 3 Answer: B | Question # 4 Answer: C | Question # 5 Answer: B |


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