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AAPC CPB Exam Syllabus Topics:

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

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AAPC Certified Professional Biller (CPB) Sample Questions (Q216-Q221):

NEW QUESTION # 216
What is the provider's responsibility when a patient has a copayment?

Answer: A

Explanation:
Copayments are patient responsibility and should be collected at the time of service.


NEW QUESTION # 217
FCA

Answer: C


NEW QUESTION # 218
What does AHIMA stand for?

Answer: A


NEW QUESTION # 219
What is Allowed Charge?

Answer: B


NEW QUESTION # 220
The medical prefixes "end-" and "endo-" mean:

Answer: A


NEW QUESTION # 221
......

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