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AAPC CPB Actual Tests : Certified Professional Biller (CPB)

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AAPC CPB Exam Syllabus Topics:

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

AAPC Certified Professional Biller (CPB) Sample Questions:

1. Which part of the body does crani refer to?

A) skull
B) skeleton
C) bones


2. What is accreditation?

A) Voluntary Process that a healthcare facility or organization (e.g. hospital or managed care plan) undergoes to demonstrate that it has met standards beyond those required by law.
B) Involuntary Process that a healthcare facility or organization (e.g. hospital or managed care plan) undergoes to demonstrate that it has met standards beyond those required by law.


3. What is Ambulatory Surgical Center Payment Rate?

A) Determined amount for which ASC services are reimbursed, at 80 percent before adjustment for regional wage variations.
B) Determined amount for which ASC services are reimbursed, at 80 percent after adjustment for regional wage variations.
C) Predetermined amount for which ASC services are reimbursed, at 80 percent before adjustment for regional wage variations.
D) Predetermined amount for which ASC services are reimbursed, at 80 percent after adjustment for regional wage variations.


4. What does it mean by juxta?

A) near
B) far


5. CMP

A) UB04 Claim used by institutional and other selected providers to
B) Insurance claim used by noninstitutional providers and supplier to bill payers
C) Centers of Medicare and Medicaid Services
D) Competitive Medical Plan


Solutions:

Question # 1
Answer: A
Question # 2
Answer: A
Question # 3
Answer: D
Question # 4
Answer: A
Question # 5
Answer: D

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