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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Insurance and Reimbursement | 20-25% | - 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 Fundamentals | 15-20% | - Revenue cycle overview - Healthcare documentation principles - Anatomy and physiology for billers - Medical terminology basics |
| Topic 3: ICD-10-CM Diagnosis Coding | 15-20% | - Secondary diagnosis coding - Code accuracy and specificity - Chapter-specific guidelines - Principal diagnosis selection - ICD-10-CM structure and conventions |
| Topic 4: Practice Management | 10-15% | - Insurance verification processes - Collections and payment posting - Accounts receivable management - Patient registration and demographics - Patient responsibility calculations |
| Topic 5: CPT Coding | 20-25% | - 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 Regulations | 10-15% | - 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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