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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Insurance and Reimbursement | 20-25% | - Claims submission and processing - Coordination of benefits - Fee schedules and reimbursement methodologies - Government payers (Medicare, Medicaid, TRICARE) - Commercial insurance policies - Workers' compensation and no-fault billing |
| Topic 2: Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Healthcare documentation principles - Medical terminology basics - Anatomy and physiology for billers |
| Topic 3: Practice Management | 10-15% | - Collections and payment posting - Insurance verification processes - Patient registration and demographics - Accounts receivable management - Patient responsibility calculations |
| Topic 4: ICD-10-CM Diagnosis Coding | 15-20% | - Secondary diagnosis coding - ICD-10-CM structure and conventions - Chapter-specific guidelines - Principal diagnosis selection - Code accuracy and specificity |
| Topic 5: CPT Coding | 20-25% | - Modifiers and their appropriate use - CPT code categories and structure - Surgical procedure codes - Category II and III codes - Evaluation and Management (E/M) codes |
| Topic 6: Billing Compliance and Regulations | 10-15% | - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics - Documentation compliance - Appeal and denial management - HIPAA privacy and security requirements |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. Which part of the body does crani refer to?
A) bones
B) skull
C) skeleton
2. GPWW stands for Group Practice Without Walls.
A) FALSE
B) TRUE
3. What are actions inconsistent with accepted, sound medical business or fiscal practice?
A) Neglect
B) Addiction
C) Abuse
D) Violence
4. Which professional association was founded to improve the quality of medical records and current advances toward an electronic and global environment including the implementation of ICD10CM
A) American Health Information Management Association (AHIMA)
B) American Academy of Professional Coders (AAPC)
C) Joint venture between Blue Cross and Blue shield where the corporations shared one building and computer services but maintained separate corporate identities
D) An association of independent Blue Cross Blue Shield plans
5. bronch
A) neck, cervix
B) heart
C) bronchial tube
D) head
Solutions:
| Question # 1 Answer: B | Question # 2 Answer: B | Question # 3 Answer: C | Question # 4 Answer: A | Question # 5 Answer: C |
