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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Claims and Billing | 14% | - Denials, appeals, corrections - Electronic claims, clearinghouses - Timely filing rules - Claim submission, tracking, follow-up |
| Topic 2: Billing Regulations | 13% | - Payer payment policies - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages - CMS-1500, UB-04 completion |
| Topic 3: Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Topic 4: Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Payment posting, adjustments - Accounts receivable management - Patient statements, collections |
| Topic 5: Types of Insurance | 21% | - Managed care plans - Commercial payers - Third-party liability - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation |
| Topic 6: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Compliance programs - Medical record retention - Privacy, security, transaction standards |
| Topic 7: Case Analysis | 17% | - Eligibility verification - End-to-end billing scenarios - Adjudication and resolution |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. Which of the following suffixes does NOT mean blood?
A) hema
B) hem
C) hemat
D) dacry
2. What does the acronym E/M stand for in medical coding?
A) Explanation of Benefits
B) Electronic Medical Record
C) Electronic Media Claim
D) Evaluation and Management
3. 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)
4. GCPI stands for Geographic Cost Practice Index.
A) TRUE
B) FALSE
5. in
A) in, into, not
B) within, into
C) between
Solutions:
| Question # 1 Answer: D | Question # 2 Answer: D | Question # 3 Answer: D | Question # 4 Answer: A | Question # 5 Answer: A |
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Dora 
Kennedy 
Myra 
Phil 
Kirk 
Philip 
Levi 
Cara 
Montague 
Lindsay 
Theobald 
Bertha 
Levi 
Maxine 
Ogden 
Henry 
Ellis 
Atwood 
Hyman 
Abraham 
Sheila 
Melissa 
