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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Billing Regulations | 13% | - CMS-1500, UB-04 completion - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - Payer payment policies |
| Claims and Billing | 14% | - Timely filing rules - Claim submission, tracking, follow-up - Electronic claims, clearinghouses - Denials, appeals, corrections |
| Types of Insurance | 21% | - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Commercial payers - Third-party liability - Medicare, Medigap, Medicaid |
| Coding Concepts for Billers | 12% | - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers |
| Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Payment posting, adjustments - Patient statements, collections - Accounts receivable management |
| HIPAA and Compliance | 9% | - Medical record retention - Fraud, abuse, False Claims Act - Compliance programs - Privacy, security, transaction standards |
| Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
AAPC Certified Professional Biller (CPB) Sample Questions:
What are actions inconsistent with accepted, sound medical business or fiscal practice?
- A. Neglect
- B. Addiction
- C. Abuse
- D. Violence
Blue Cross Blue Shield (BCBS) is joint venture between Blue Cross and Blue Shield where the corporation shared one building and computer.
- A. FALSE
- B. TRUE
Adverse Effect is also called adverse reaction; the appearance of a pathologic condition due to ingestion r exposure to a chemical substance properly administered or taken.
- A. FALSE
- B. TRUE
anti
- A. against
- B. joint
- C. condition
What does it mean by dacry?
- A. urine
- B. sweat
- C. stool
- D. tear
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