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AAPC CPB Exam Syllabus Topics:

SectionWeightObjectives
Topic 1: Insurance and Reimbursement20-25%- Government payers (Medicare, Medicaid, TRICARE)
- Claims submission and processing
- Commercial insurance policies
- Workers' compensation and no-fault billing
- Fee schedules and reimbursement methodologies
- Coordination of benefits
Topic 2: Healthcare Billing Fundamentals15-20%- Revenue cycle overview
- Healthcare documentation principles
- Anatomy and physiology for billers
- Medical terminology basics
Topic 3: ICD-10-CM Diagnosis Coding15-20%- Secondary diagnosis coding
- Code accuracy and specificity
- Chapter-specific guidelines
- Principal diagnosis selection
- ICD-10-CM structure and conventions
Topic 4: Practice Management10-15%- Insurance verification processes
- Collections and payment posting
- Accounts receivable management
- Patient registration and demographics
- Patient responsibility calculations
Topic 5: CPT Coding20-25%- Category II and III codes
- Evaluation and Management (E/M) codes
- CPT code categories and structure
- Surgical procedure codes
- Modifiers and their appropriate use
Topic 6: Billing Compliance and Regulations10-15%- Fraud, waste, and abuse prevention
- Appeal and denial management
- Stark Law and Anti-Kickback Statute basics
- HIPAA privacy and security requirements
- Documentation compliance

AAPC Certified Professional Biller (CPB) Sample Questions:

1. The medical prefix "hyper-" means:

A) condition
B) uterus, womb
C) above, excessive


2. Blue Cross Blue Shield Association (BCBSA) is an association of independent Blue Cross Blue Shield plans.

A) TRUE
B) FALSE


3. What does it mean by galact and lact?

A) water
B) milk
C) alcohol


4. HSSA stands for Health Savings Security Account.

A) TRUE
B) FALSE


5. bronch

A) heart
B) bronchial tube
C) neck, cervix
D) head


Solutions:

Question # 1
Answer: C
Question # 2
Answer: A
Question # 3
Answer: B
Question # 4
Answer: A
Question # 5
Answer: B

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