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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Practice Management | 10-15% | - Insurance verification processes - Collections and payment posting - Patient registration and demographics - Patient responsibility calculations - Accounts receivable management |
| CPT Coding | 20-25% | - Category II and III codes - Surgical procedure codes - CPT code categories and structure - Modifiers and their appropriate use - Evaluation and Management (E/M) codes |
| Billing Compliance and Regulations | 10-15% | - Appeal and denial management - HIPAA privacy and security requirements - Fraud, waste, and abuse prevention - Documentation compliance - Stark Law and Anti-Kickback Statute basics |
| ICD-10-CM Diagnosis Coding | 15-20% | - Chapter-specific guidelines - Code accuracy and specificity - ICD-10-CM structure and conventions - Secondary diagnosis coding - Principal diagnosis selection |
| Healthcare Billing Fundamentals | 15-20% | - Healthcare documentation principles - Revenue cycle overview - Medical terminology basics - Anatomy and physiology for billers |
| Insurance and Reimbursement | 20-25% | - Claims submission and processing - Coordination of benefits - Fee schedules and reimbursement methodologies - Commercial insurance policies - Government payers (Medicare, Medicaid, TRICARE) - Workers' compensation and no-fault billing |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. FATHOM
A) False Claims Act
B) First Look Analysis for Hospital Outlier Monitoring
C) Federal Employment Compensation Act
D) Fair Debt Collection Practices Act
2. Case management is development of patient care plans to coordinate and provide care for complicated cases in a cost effective manner.
A) TRUE
B) FALSE
3. HHRG stands for Home Health Resource Group.
A) TRUE
B) FALSE
4. What does ADA stand for?
A) Americans with Disabilities Act
B) Australians with Disabilities Act
C) Asians with Disabilities Act
D) Africans with Disabilities Act
5. What does the acronym E/M stand for in medical coding?
A) Electronic Medical Record
B) Explanation of Benefits
C) Electronic Media Claim
D) Evaluation and Management
Solutions:
| Question # 1 Answer: B | Question # 2 Answer: A | Question # 3 Answer: A | Question # 4 Answer: A | Question # 5 Answer: D |
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