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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Reimbursement and Collections | 14% | - Accounts receivable management - Refunds, payment plans, write-offs - Patient statements, collections - Payment posting, adjustments |
| Billing Regulations | 13% | - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Payer payment policies |
| Case Analysis | 17% | - Eligibility verification - End-to-end billing scenarios - Adjudication and resolution |
| HIPAA and Compliance | 9% | - Medical record retention - Compliance programs - Fraud, abuse, False Claims Act - Privacy, security, transaction standards |
| Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Third-party liability - Managed care plans - Commercial payers |
| Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
| Claims and Billing | 14% | - Electronic claims, clearinghouses - Denials, appeals, corrections - Timely filing rules - Claim submission, tracking, follow-up |
AAPC Certified Professional Biller (CPB) Sample Questions:
Accounts Receivable Management
- A. Assists providers in the collection of appropriate reimbursement for services rendered; include functions such as insurance verification/eligibility and preauthorization of services
- B. Voluntary Process that a healthcare facility or organization (e.g. hospital or managed care plan) undergoes to demonstrate that it has met standards beyond those required by law.
- C. Judicial dispute resolution process in which an appeals board makes a final determination.
- D. Payment correction resulting in additional payment(s) to the provider.
Correct Answer: A 🗳️
Which part of the body does cephal refer to?
- A. neck
- B. heart
- C. head
- D. vagina
Correct Answer: C 🗳️
The medical prefix "hyper-" means:
- A. uterus, womb
- B. above, excessive
- C. condition
Correct Answer: B 🗳️
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