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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers - Medical necessity |
| Topic 2: Billing Regulations | 13% | - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages - Payer payment policies |
| Topic 3: Claims and Billing | 14% | - Claim submission, tracking, follow-up - Electronic claims, clearinghouses - Timely filing rules - Denials, appeals, corrections |
| Topic 4: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Compliance programs - Privacy, security, transaction standards - Medical record retention |
| Topic 5: Reimbursement and Collections | 14% | - Payment posting, adjustments - Accounts receivable management - Refunds, payment plans, write-offs - Patient statements, collections |
| Topic 6: Case Analysis | 17% | - Eligibility verification - Adjudication and resolution - End-to-end billing scenarios |
| Topic 7: Types of Insurance | 21% | - Commercial payers - Third-party liability - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Managed care plans |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. Adjusted Claim is payment correction resulting in additional payment(s) to the provider.
A) TRUE
B) FALSE
2. 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) American Health Information Management Association (AHIMA)
C) American Academy of Professional Coders (AAPC)
D) Joint venture between Blue Cross and Blue shield where the corporations shared one building and computer services but maintained separate corporate identities
3. EGHP
A) Employer group health plan
B) Electronic Healthcare Network Accreditation Commission
C) Evaluation and Management
D) Electronic Health Record
4. The medical prefixes "end-" and "endo-" mean:
A) red
B) nervous sensation
C) in, within
D) above, upon
5. Which part of the body does cervic refer to?
A) vagina
B) skull
C) neck
D) head
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: B | Question # 3 Answer: A | Question # 4 Answer: C | Question # 5 Answer: C |
