Exam Name: Certified Professional Biller (CPB)
Certification Provider: AAPC
Corresponding Certification: AAPC Certification
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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| ICD-10-CM Diagnosis Coding | 15-20% | - ICD-10-CM structure and conventions - Chapter-specific guidelines - Secondary diagnosis coding - Code accuracy and specificity - Principal diagnosis selection |
| Insurance and Reimbursement | 20-25% | - Commercial insurance policies - Government payers (Medicare, Medicaid, TRICARE) - Workers' compensation and no-fault billing - Fee schedules and reimbursement methodologies - Coordination of benefits - Claims submission and processing |
| Healthcare Billing Fundamentals | 15-20% | - Healthcare documentation principles - Anatomy and physiology for billers - Medical terminology basics - Revenue cycle overview |
| CPT Coding | 20-25% | - Evaluation and Management (E/M) codes - Category II and III codes - Modifiers and their appropriate use - Surgical procedure codes - CPT code categories and structure |
| Practice Management | 10-15% | - Patient responsibility calculations - Insurance verification processes - Accounts receivable management - Patient registration and demographics - Collections and payment posting |
| Billing Compliance and Regulations | 10-15% | - HIPAA privacy and security requirements - Documentation compliance - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics - Appeal and denial management |
AAPC Certified Professional Biller (CPB) Sample Questions:
Ambulatory Surgical Center (ASC) includes State Licensed Medicare-certified supplier (not provider) of surgical healthcare services that must accept assignment on Medicare Claims.
- A. FALSE
- B. TRUE
Correct Answer: B 🗳️
Catastrophic cap benefit protects TRICARE beneficiaries form devastating financial loss due to serious illness or long-term treatment by establishing limits over which payments is not required.
- A. FALSE
- B. TRUE
Correct Answer: B 🗳️
EHNAC
- A. Electronic Healthcare Network Accreditation Commission
- B. Electronic Media Claim
- C. Evaluation and Management
- D. Electronic Health Record
Correct Answer: A 🗳️
Case management services is a process by which an attending physician coordinates and supervises care provided to patient by other providers.
- A. FALSE
- B. TRUE
Correct Answer: B 🗳️
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