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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Billing Regulations | 13% | - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Payer payment policies |
| Coding Concepts for Billers | 12% | - Code validation, modifiers - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II |
| Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Accounts receivable management - Patient statements, collections - Payment posting, adjustments |
| Types of Insurance | 21% | - Third-party liability - Medicare, Medigap, Medicaid - Managed care plans - Commercial payers - TRICARE/CHAMPUS, Workers' compensation |
| Claims and Billing | 14% | - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Timely filing rules - Denials, appeals, corrections |
| HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Medical record retention - Fraud, abuse, False Claims Act - Compliance programs |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. What is Blue Cross (BC)?
A) Insurance plan created in 1930 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 20 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
B) Insurance plan created in 1929 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 20 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
C) Insurance plan created in 1930 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 21 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
D) Insurance plan created in 1929 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 21 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
2. Care plan oversight services cover the physician's time supervising a complex and multidisciplinary care treatment program for specific patient who is under the care of a home health agency, hospice, or nursing facility.
A) FALSE
B) TRUE
3. The word root "hema" refers to:
A) half
B) liver
C) blood
4. What does HA stand for?
A) Home Assessment
B) Healthcare Affairs
C) Health Affairs
D) Healthcare Assessment
5. Which of the following suffixes means half?
A) bi
B) demi
C) di
Solutions:
| Question # 1 Answer: D | Question # 2 Answer: B | Question # 3 Answer: C | Question # 4 Answer: C | Question # 5 Answer: B |
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