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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Healthcare Billing Fundamentals | 15-20% | - Anatomy and physiology for billers - Medical terminology basics - Revenue cycle overview - Healthcare documentation principles |
| Topic 2: Billing Compliance and Regulations | 10-15% | - Stark Law and Anti-Kickback Statute basics - Appeal and denial management - HIPAA privacy and security requirements - Fraud, waste, and abuse prevention - Documentation compliance |
| Topic 3: CPT Coding | 20-25% | - CPT code categories and structure - Modifiers and their appropriate use - Surgical procedure codes - Category II and III codes - Evaluation and Management (E/M) codes |
| Topic 4: Insurance and Reimbursement | 20-25% | - Government payers (Medicare, Medicaid, TRICARE) - Workers' compensation and no-fault billing - Claims submission and processing - Fee schedules and reimbursement methodologies - Commercial insurance policies - Coordination of benefits |
| Topic 5: ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - Chapter-specific guidelines - ICD-10-CM structure and conventions - Principal diagnosis selection - Secondary diagnosis coding |
| Topic 6: Practice Management | 10-15% | - Insurance verification processes - Collections and payment posting - Accounts receivable management - Patient registration and demographics - Patient responsibility calculations |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. contra
A) against, opposite
B) skull
C) cold
D) blue
2. anti
A) joint
B) against
C) condition
3. What does it mean by dextr?
A) right
B) left
4. Preauthorization is an authorization that must be received from a payer before treatment by a specialist will be covered.
A) TRUE
B) FALSE
5. EDD
A) Employer group health plan
B) Electronic funds transfer
C) (California) Employment Development Department
D) Electronic data interchange
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: B | Question # 3 Answer: A | Question # 4 Answer: A | Question # 5 Answer: C |
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