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AAPC CPB Exam Syllabus Topics:

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

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AAPC Certified Professional Biller (CPB) Sample Questions (Q73-Q78):

NEW QUESTION # 73
Ambulance Fee Schedule is payment system for ambulance services provided to Medicare Beneficiaries.

Answer: A


NEW QUESTION # 74
Preauthorization is an authorization that must be received from a payer before treatment by a specialist will be covered.

Answer: A


NEW QUESTION # 75
What is the primary purpose of National Correct Coding Initiative (NCCI) edits?

Answer: B

Explanation:
NCCI edits prevent unbundling and inappropriate coding combinations.


NEW QUESTION # 76
What does AMA stand for?

Answer: A


NEW QUESTION # 77
What does it mean by graph?

Answer: C


NEW QUESTION # 78
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