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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Healthcare documentation principles - Medical terminology basics - Anatomy and physiology for billers |
| Topic 2: CPT Coding | 20-25% | - Category II and III codes - CPT code categories and structure - Surgical procedure codes - Evaluation and Management (E/M) codes - Modifiers and their appropriate use |
| Topic 3: Practice Management | 10-15% | - Insurance verification processes - Collections and payment posting - Patient responsibility calculations - Accounts receivable management - Patient registration and demographics |
| Topic 4: ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - Chapter-specific guidelines - ICD-10-CM structure and conventions - Secondary diagnosis coding - Principal diagnosis selection |
| Topic 5: Billing Compliance and Regulations | 10-15% | - Documentation compliance - Appeal and denial management - Stark Law and Anti-Kickback Statute basics - Fraud, waste, and abuse prevention - HIPAA privacy and security requirements |
| Topic 6: Insurance and Reimbursement | 20-25% | - Claims submission and processing - Commercial insurance policies - Government payers (Medicare, Medicaid, TRICARE) - Fee schedules and reimbursement methodologies - Workers' compensation and no-fault billing - Coordination of benefits |
AAPC Certified Professional Biller (CPB) Sample Questions:
What should be done if an insurance company incorrectly denies a covered service?
- A. Write off the charge
- B. Bill the patient immediately
- C. Resubmit the same claim without changes
- D. File an appeal with supporting documentation
Correct Answer: D 🗳️
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FPL
- A. General Equivalency Mapping
- B. Federal Poverty Level
- C. Flexible Spending Account
- D. Federal Register
Correct Answer: B 🗳️
A patient has Medicare as primary and a commercial plan as secondary. Which insurance should be billed first?
- A. Secondary insurance
- B. Medicare
- C. Medicaid
- D. Commercial insurance
Correct Answer: B 🗳️
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Catchment area is the region defined by code boundaries within a 40mile radius of a military treatment facility.
- A. TRUE
- B. FALSE
Correct Answer: A 🗳️
What does it mean by dacry?
- A. sweat
- B. stool
- C. tear
- D. urine
Correct Answer: C 🗳️
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