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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers - Medical necessity |
| Types of Insurance | 21% | - Medicare, Medigap, Medicaid - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Managed care plans |
| Claims and Billing | 14% | - Electronic claims, clearinghouses - Timely filing rules - Claim submission, tracking, follow-up - Denials, appeals, corrections |
| Billing Regulations | 13% | - CMS-1500, UB-04 completion - Payer payment policies - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs |
| Reimbursement and Collections | 14% | - Accounts receivable management - Refunds, payment plans, write-offs - Payment posting, adjustments - Patient statements, collections |
| Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| HIPAA and Compliance | 9% | - Medical record retention - Compliance programs - Fraud, abuse, False Claims Act - Privacy, security, transaction standards |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. CMP
A) UB04 Claim used by institutional and other selected providers to
B) Insurance claim used by noninstitutional providers and supplier to bill payers
C) Centers of Medicare and Medicaid Services
D) Competitive Medical Plan
2. EMC
A) Exclusive provider organization
B) Electronic Media Claim
C) Electronic Medical Record
D) Explanation of Benefits
3. Case management services is a process by which an attending physician coordinates and supervises care provided to patient by other providers.
A) TRUE
B) FALSE
4. American Association of Medical Assistants (AAMA) enables medical assisting professionals to enhance and demonstrate the knowledge, skills, and professionalism required by employers and patients; as well as protect medical assistants' right to practice.
A) TRUE
B) FALSE
5. EDD
A) Electronic funds transfer
B) Employer group health plan
C) (California) Employment Development Department
D) Electronic data interchange
Solutions:
| Question # 1 Answer: D | Question # 2 Answer: B | Question # 3 Answer: A | Question # 4 Answer: A | Question # 5 Answer: C |
