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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: HIPAA and Compliance | 9% | - Medical record retention - Fraud, abuse, False Claims Act - Compliance programs - Privacy, security, transaction standards |
| Topic 2: Claims and Billing | 14% | - Claim submission, tracking, follow-up - Denials, appeals, corrections - Timely filing rules - Electronic claims, clearinghouses |
| Topic 3: Billing Regulations | 13% | - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Payer payment policies - Incident-to billing, global packages |
| Topic 4: Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management |
| Topic 5: Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
| Topic 6: Types of Insurance | 21% | - Medicare, Medigap, Medicaid - Third-party liability - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Commercial payers |
| Topic 7: Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. FMAP stands for Federal Medical Assistance Percentage.
A) TRUE
B) FALSE
2. Accept Assignment
A) The amount owed to a business for services or goods provided.
B) Assists providers in the collection of appropriate reimbursement for services rendered; include functions such as insurance verification/eligibility and preauthorization of services.
C) Shows the status (by date) of outstanding claims from each payer, as well as payments due from patients.
D) Provider accepts as payment in full whatever is paid on the claim by the payer (except for any copayment and or coinsurance amounts.)
3. CPC
A) Current Procedural Terminology
B) Certified Professional Coder
C) CHAMPUS Reform Initiative
D) Customized SubCapitation Plan
4. What are Category I Codes?
A) Optional performance measurement tracking codes that are assigned an alphanumeric identifier with a letter in the last field (e,g.,1234A); these codes will be located after the medicine section; their use is optional.
B) Temporary codes for data collection purposes that are assigned an alphanumeric identifier with a letter in the last field (e.g., 0001T) these codes are located after the Medicine section, and will be archived after five years unless accepted for placement within Category I sections of CPT.
C) Procedures/ services identified by a five digit CPT code and descriptor nomenclature; these codes are traditionally associated with CPT and organized within six sections.
5. What does CDT stand for?
A) Conversion Dental Terminology
B) Comprehensive Dental Terminology
C) Current Dental Terminology
D) Civilian Dental Terminology
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: D | Question # 3 Answer: B | Question # 4 Answer: C | Question # 5 Answer: C |




