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AAPC CPB Exam Syllabus Topics:

SectionWeightObjectives
Topic 1: Billing Compliance and Regulations10-15%- Appeal and denial management
- Documentation compliance
- HIPAA privacy and security requirements
- Stark Law and Anti-Kickback Statute basics
- Fraud, waste, and abuse prevention
Topic 2: CPT Coding20-25%- Evaluation and Management (E/M) codes
- Modifiers and their appropriate use
- CPT code categories and structure
- Surgical procedure codes
- Category II and III codes
Topic 3: ICD-10-CM Diagnosis Coding15-20%- Code accuracy and specificity
- ICD-10-CM structure and conventions
- Chapter-specific guidelines
- Principal diagnosis selection
- Secondary diagnosis coding
Topic 4: Healthcare Billing Fundamentals15-20%- Revenue cycle overview
- Anatomy and physiology for billers
- Healthcare documentation principles
- Medical terminology basics
Topic 5: Insurance and Reimbursement20-25%- Workers' compensation and no-fault billing
- Fee schedules and reimbursement methodologies
- Government payers (Medicare, Medicaid, TRICARE)
- Claims submission and processing
- Coordination of benefits
- Commercial insurance policies
Topic 6: Practice Management10-15%- Patient registration and demographics
- Collections and payment posting
- Insurance verification processes
- Accounts receivable management
- Patient responsibility calculations

AAPC Certified Professional Biller (CPB) Sample Questions:

1. HRA stands for Health Reimbursement Arrangement.

A) TRUE
B) FALSE


2. What is the provider's responsibility when a patient has a copayment?

A) Bill it to insurance
B) Collect it at the time of service
C) Waive it routinely
D) Write it off automatically


3. A patient has Medicare as primary and a commercial plan as secondary. Which insurance should be billed first?

A) Commercial insurance
B) Medicare
C) Secondary insurance
D) Medicaid


4. The medical prefixes "hypo-" or "hyp-" mean:

A) above, excessive
B) uterus, womb
C) below, under
D) condition


5. FMAP stands for Federal Medical Assistance Percentage.

A) TRUE
B) FALSE


Solutions:

Question # 1
Answer: A
Question # 2
Answer: B
Question # 3
Answer: B
Question # 4
Answer: C
Question # 5
Answer: A

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