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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: ICD-10-CM Diagnosis Coding | 15-20% | - Principal diagnosis selection - Code accuracy and specificity - Chapter-specific guidelines - ICD-10-CM structure and conventions - Secondary diagnosis coding |
| Topic 2: Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Healthcare documentation principles - Medical terminology basics - Anatomy and physiology for billers |
| Topic 3: Practice Management | 10-15% | - Collections and payment posting - Patient registration and demographics - Patient responsibility calculations - Insurance verification processes - Accounts receivable management |
| Topic 4: Insurance and Reimbursement | 20-25% | - Claims submission and processing - Government payers (Medicare, Medicaid, TRICARE) - Commercial insurance policies - Workers' compensation and no-fault billing - Fee schedules and reimbursement methodologies - Coordination of benefits |
| Topic 5: Billing Compliance and Regulations | 10-15% | - HIPAA privacy and security requirements - Appeal and denial management - Documentation compliance - Stark Law and Anti-Kickback Statute basics - Fraud, waste, and abuse prevention |
| Topic 6: CPT Coding | 20-25% | - Modifiers and their appropriate use - Category II and III codes - CPT code categories and structure - Surgical procedure codes - Evaluation and Management (E/M) codes |
AAPC Certified Professional Biller (CPB) Sample Questions:
Question #1
A patient has Medicare as primary and a commercial plan as secondary. Which insurance should be billed first?
A. Medicare
B. Secondary insurance
C. Commercial insurance
D. Medicaid
Question #2
What is the primary purpose of National Correct Coding Initiative (NCCI) edits?
A. Replace CPT guidelines
B. Set reimbursement rates
C. Identify unbundling and improper coding
D. Increase claim approvals
Question #3
What are Category II 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 assigned an alphanumeric identifier with a letter in the last field (e,g.,1234A); these codes will be located after the medicine section; their use is optional.
Question #4
Cafeteria plan is also called triple option plan; provides different health benefits plans and extra coverage options through an insure or third-party administrator.
A. TRUE
B. FALSE
Question #5
The medical prefixes "end-" and "endo-" mean:
A. red
B. in, within
C. nervous sensation
D. above, upon
Solutions:
| Question #1 Correct Answer: A | Question #2 Correct Answer: C | Question #3 Correct Answer: C | Question #4 Correct Answer: A | Question #5 Correct Answer: B |
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