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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Billing Regulations | 13% | - Incident-to billing, global packages - CMS-1500, UB-04 completion - Payer payment policies - ACOs, NCCI, LCDs, NCDs |
| Topic 2: Reimbursement and Collections | 14% | - Payment posting, adjustments - Refunds, payment plans, write-offs - Patient statements, collections - Accounts receivable management |
| Topic 3: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Medical record retention - Compliance programs - Privacy, security, transaction standards |
| Topic 4: Types of Insurance | 21% | - Third-party liability - Managed care plans - Commercial payers - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation |
| Topic 5: Case Analysis | 17% | - Eligibility verification - Adjudication and resolution - End-to-end billing scenarios |
| Topic 6: Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
| Topic 7: Claims and Billing | 14% | - Claim submission, tracking, follow-up - Denials, appeals, corrections - Electronic claims, clearinghouses - Timely filing rules |
AAPC Certified Professional Biller (CPB) Sample Questions:
What does it mean by cyan?
- A. yellow
- B. green
- C. red
- D. blue
Correct Answer: D 🗳️
A patient has Medicare as primary and a commercial plan as secondary. Which insurance should be billed first?
- A. Commercial insurance
- B. Secondary insurance
- C. Medicaid
- D. Medicare
Correct Answer: D 🗳️
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EFT
- A. Electronic Healthcare Network Accreditation Commission
- B. Electronic Health Record
- C. Employer group health plan
- D. Electronic funds transfer
Correct Answer: D 🗳️
CMS
- A. Insurance claim used by noninstitutional providers and supplier to bill payers
- B. Clinical nurse specialist
- C. Centers of Medicare and Medicaid Services
- D. UB04 Claim used by institutional and other selected providers to bill payers
Correct Answer: C 🗳️
What does HA stand for?
- A. Health Affairs
- B. Healthcare Affairs
- C. Healthcare Assessment
- D. Home Assessment
Correct Answer: A 🗳️





