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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Billing Regulations | 13% | - Payer payment policies - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion |
| Topic 2: Claims and Billing | 14% | - Timely filing rules - Denials, appeals, corrections - Electronic claims, clearinghouses - Claim submission, tracking, follow-up |
| Topic 3: Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Managed care plans - Commercial payers - Third-party liability |
| Topic 4: Case Analysis | 17% | - Eligibility verification - End-to-end billing scenarios - Adjudication and resolution |
| Topic 5: HIPAA and Compliance | 9% | - Compliance programs - Privacy, security, transaction standards - Medical record retention - Fraud, abuse, False Claims Act |
| Topic 6: Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Patient statements, collections - Payment posting, adjustments - Accounts receivable management |
| Topic 7: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity - Code validation, modifiers |
AAPC Certified Professional Biller (CPB) Sample Questions:
Carcinoma (Ca) in situ is a malignant tumor that is localized, circumscribed, encapsulated, and noninvasive (has not spread to deeper or adjacent tissues or organs).
- A. TRUE
- B. FALSE
Correct Answer: A 🗳️
HCPCS stands for Healthcare Common Procedure Coding System.
- A. TRUE
- B. FALSE
Correct Answer: A 🗳️
What are Category III codes?
- A. Temporary codes for data collection purposes that are assigned an alphanumeric identifier with a letter in the last field (e.g., 0001T) these codes are located after the Medicine section, and will be archived after five years unless accepted for placement within Category I sections of CPT.
- B. Procedures/ services identified by a five digit CPT code and descriptor nomenclature; these codes are traditionally associated with CPT and organized within six sections.
- C. Optional performance measurement tracking codes that are field (e,g.,1234A); these codes will be located after the medicine section; their use is optional.
Correct Answer: A 🗳️
BCAC stands for Beneficiary Counseling and Assistance Coordinator.
- A. TRUE
- B. FALSE
Correct Answer: A 🗳️
Which of the following suffixes refers to in?
- A. ex
- B. extra
- C. en
- D. red
Correct Answer: C 🗳️
Eric 
Gustave 
Justin 
Barret 
Miles 
Zachary 
Mag 
Dennis 
Sally 
Arvin 
Kama 
Jeff 
Cheryl 
Louis 
Hilda 
Neil 
Leona 
Mandel 
Eden 
