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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Case Analysis | 17% | - End-to-end billing scenarios - Adjudication and resolution - Eligibility verification |
| Topic 2: Coding Concepts for Billers | 12% | - Code validation, modifiers - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II |
| Topic 3: Reimbursement and Collections | 14% | - Accounts receivable management - Patient statements, collections - Refunds, payment plans, write-offs - Payment posting, adjustments |
| Topic 4: Claims and Billing | 14% | - Denials, appeals, corrections - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Timely filing rules |
| Topic 5: Billing Regulations | 13% | - Incident-to billing, global packages - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Payer payment policies |
| Topic 6: Types of Insurance | 21% | - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Third-party liability - Commercial payers |
| Topic 7: HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Compliance programs - Medical record retention - Fraud, abuse, False Claims Act |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. Which is a professional member of the healthcare team who provides services or supplies to the insured?
A) Healthcare Provider
B) Health Insurance Specialist
C) Independent Contractor
2. The medical prefix "ab-" means:
A) toward
B) abdomen
C) away from
D) extremities, top
3. What is All Patient DiagnosisRelated Group (APDRG)?
A) Adopted by Medicare in 2008 to reimburse hospitals for inpatient care provided to Medicare beneficiaries; expanded original DRG system (based on intensity of resources) to add two subclasses to each DRG that adjusts Medicare inpatient hospital reimbursement rates for severity of illness (SOI) (extent of physiological decompensation or organ system loss of function) and risk of mortality (ROM) (likelihood of dying); each subclass, in turn, is subdivided into four areas: (1) minor, (2) moderate, (3) major, (4) extreme.
B) DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to nonMedicare beneficiaries (e.g. Blue Cross BlueShield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources.
4. The medical word root "ankyl/o" (or "ankyl") means:
A) joint
B) against
C) crooked, bent
D) condition
5. What does it mean by graphy?
A) process of publishing
B) process of recording
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: C | Question # 3 Answer: B | Question # 4 Answer: C | Question # 5 Answer: B |
