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- Total Questions: 245
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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Claims and Billing | 14% | - Claim submission, tracking, follow-up - Timely filing rules - Denials, appeals, corrections - Electronic claims, clearinghouses |
| Case Analysis | 17% | - Eligibility verification - Adjudication and resolution - End-to-end billing scenarios |
| Types of Insurance | 21% | - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Third-party liability - Medicare, Medigap, Medicaid |
| HIPAA and Compliance | 9% | - Compliance programs - Medical record retention - Fraud, abuse, False Claims Act - Privacy, security, transaction standards |
| Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Payer payment policies - CMS-1500, UB-04 completion - Incident-to billing, global packages |
| Coding Concepts for Billers | 12% | - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers |
| Reimbursement and Collections | 14% | - Accounts receivable management - Patient statements, collections - Refunds, payment plans, write-offs - Payment posting, adjustments |
AAPC Certified Professional Biller (CPB) Sample Questions:
Which professional association was founded to elevate the standards of medical coding by providing certification, ongoing education, networking, and recognition for coders?
- A. Joint venture between Blue Cross and Blue shield where the corporations shared one building and computer services but maintained separate corporate identities
- B. American Health Information Management Association (AHIMA)
- C. An association of independent Blue Cross Blue Shield plans
- D. American Academy of Professional Coders (AAPC)
Correct Answer: D 🗳️
What does it mean by gyn, gyne and gynec?
- A. women, female
- B. men, male
Correct Answer: A 🗳️
What are actions inconsistent with accepted, sound medical business or fiscal practice?
- A. Neglect
- B. Abuse
- C. Violence
- D. Addiction
Correct Answer: B 🗳️
ASC (Choose two.)
- A. Accredited Standards Committee
- B. Beneficiary Counseling and Assistance Coordinator
- C. Blue Cross
- D. Ambulatory Surgical Center
Correct Answer: A,D 🗳️
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