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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Claims and Billing | 14% | - Denials, appeals, corrections - Claim submission, tracking, follow-up - Electronic claims, clearinghouses - Timely filing rules |
| Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Payer payment policies - Incident-to billing, global packages |
| Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| Types of Insurance | 21% | - Third-party liability - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Commercial payers |
| Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
| Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management |
| HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Compliance programs - Medical record retention - Fraud, abuse, False Claims Act |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. What does GEM stand for?
A) Geographic Equivalency Mapping
B) Group Enrollment Management
C) General Equivalency Mapping
D) General Enrollment Management
2. FCA
A) False Claims Act
B) Federal Employment Compensation Act
C) Fair Debt Collection Practices Act
D) Federal Employee Health Benefit Program
3. What is Blue Cross (BC)?
A) Insurance plan created in 1929 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 20 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
B) Insurance plan created in 1930 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 20 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
C) Insurance plan created in 1930 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 21 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
D) Insurance plan created in 1929 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 21 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.
4. Case management is development of patient care plans to coordinate and provide care for complicated cases in a cost effective manner.
A) TRUE
B) FALSE
5. What document is used to transfer patient financial responsibility after insurance adjudication?
A) CMS-1500
B) Patient Statement
C) Prior Authorization
D) UB-04
Solutions:
| Question # 1 Answer: C | Question # 2 Answer: A | Question # 3 Answer: D | Question # 4 Answer: A | Question # 5 Answer: B |
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