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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Practice Management | 10-15% | - Insurance verification processes - Patient registration and demographics - Patient responsibility calculations - Accounts receivable management - Collections and payment posting |
| Topic 2: CPT Coding | 20-25% | - Evaluation and Management (E/M) codes - Modifiers and their appropriate use - Category II and III codes - CPT code categories and structure - Surgical procedure codes |
| Topic 3: Billing Compliance and Regulations | 10-15% | - HIPAA privacy and security requirements - Stark Law and Anti-Kickback Statute basics - Appeal and denial management - Documentation compliance - Fraud, waste, and abuse prevention |
| Topic 4: ICD-10-CM Diagnosis Coding | 15-20% | - Principal diagnosis selection - Secondary diagnosis coding - Code accuracy and specificity - Chapter-specific guidelines - ICD-10-CM structure and conventions |
| Topic 5: Healthcare Billing Fundamentals | 15-20% | - Healthcare documentation principles - Medical terminology basics - Revenue cycle overview - Anatomy and physiology for billers |
| Topic 6: Insurance and Reimbursement | 20-25% | - Claims submission and processing - Fee schedules and reimbursement methodologies - Government payers (Medicare, Medicaid, TRICARE) - Commercial insurance policies - Coordination of benefits - Workers' compensation and no-fault billing |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. DMERC
A) Diagnosis related groups
B) Department of Defense
C) Durable Medical Equipment regional carriers
D) Disproportionate share hospital (adjustment)
2. HHRG stands for Home Health Resource Group.
A) FALSE
B) TRUE
3. FCA
A) Fair Debt Collection Practices Act
B) Federal Employment Compensation Act
C) False Claims Act
D) Federal Employee Health Benefit Program
4. The medical prefixes "a-" and "an-" mean:
A) no, not
B) extremities, top
C) away from
D) abdomen
5. What does GEM stand for?
A) Geographic Equivalency Mapping
B) General Equivalency Mapping
C) Group Enrollment Management
D) General Enrollment Management
Solutions:
| Question # 1 Answer: C | Question # 2 Answer: B | Question # 3 Answer: C | Question # 4 Answer: A | Question # 5 Answer: B |
