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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - ICD-10-CM structure and conventions - Principal diagnosis selection - Chapter-specific guidelines - Secondary diagnosis coding |
| Topic 2: CPT Coding | 20-25% | - Evaluation and Management (E/M) codes - CPT code categories and structure - Modifiers and their appropriate use - Category II and III codes - Surgical procedure codes |
| Topic 3: Billing Compliance and Regulations | 10-15% | - Appeal and denial management - Documentation compliance - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics - HIPAA privacy and security requirements |
| Topic 4: Insurance and Reimbursement | 20-25% | - Commercial insurance policies - Fee schedules and reimbursement methodologies - Coordination of benefits - Workers' compensation and no-fault billing - Claims submission and processing - Government payers (Medicare, Medicaid, TRICARE) |
| Topic 5: Practice Management | 10-15% | - Collections and payment posting - Patient responsibility calculations - Insurance verification processes - Patient registration and demographics - Accounts receivable management |
| Topic 6: Healthcare Billing Fundamentals | 15-20% | - Healthcare documentation principles - Revenue cycle overview - Anatomy and physiology for billers - Medical terminology basics |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. CRI
A) Customized SubCapitation Plan
B) Debt Collection Assistance Officer
C) CHAMPUS Reform Initiative
D) Computed Tomography
2. What does BC stand for?
A) Beneficiary Counseling
B) Beneficiary Association
C) Blue Cross
D) Black Cross
3. What is the main purpose of an audit in medical billing?
A) Speed up reimbursements
B) Punish billers
C) Increase workload
D) Ensure billing accuracy and compliance
4. fore
A) stomach
B) before
C) genitals
D) milk
5. The medical word root "ankyl/o" (or "ankyl") means:
A) joint
B) against
C) condition
D) crooked, bent
Solutions:
| Question # 1 Answer: C | Question # 2 Answer: C | Question # 3 Answer: D | Question # 4 Answer: B | Question # 5 Answer: D |
