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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| HIPAA and Compliance | 9% | - Compliance programs - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Medical record retention |
| Coding Concepts for Billers | 12% | - Code validation, modifiers - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II |
| Billing Regulations | 13% | - Incident-to billing, global packages - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Payer payment policies |
| Types of Insurance | 21% | - Managed care plans - Commercial payers - Medicare, Medigap, Medicaid - Third-party liability - TRICARE/CHAMPUS, Workers' compensation |
| Reimbursement and Collections | 14% | - Patient statements, collections - Refunds, payment plans, write-offs - Payment posting, adjustments - Accounts receivable management |
| Claims and Billing | 14% | - Timely filing rules - Denials, appeals, corrections - Electronic claims, clearinghouses - Claim submission, tracking, follow-up |
AAPC Certified Professional Biller (CPB) Sample Questions:
Business liability insurance protects business assets and covers the cost of lawsuits resulting from bodily injury, and false advertising.
- A. FALSE
- B. TRUE
Correct Answer: B 🗳️
837
- A. Claims validation table (as in ANSI ASC X12 837)
- B. Claims validation table (as in ANSI ASC X10 837)
- C. Claims validation table (as in ANSI ASC X11 837)
- D. Claims validation table (as in ANSI ASC X13 837)
Correct Answer: A 🗳️
HCPCS stands for Healthcare Common Procedure Coding System.
- A. FALSE
- B. TRUE
Correct Answer: B 🗳️
HRA stands for Health Reimbursement Arrangement.
- A. FALSE
- B. TRUE
Correct Answer: B 🗳️
Catastrophic cap benefit protects TRICARE beneficiaries form devastating financial loss due to serious illness or long-term treatment by establishing limits over which payments is not required.
- A. FALSE
- B. TRUE
Correct Answer: B 🗳️
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