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AAPC CPB Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| ICD-10-CM Diagnosis Coding | 15-20% | - Principal diagnosis selection - Secondary diagnosis coding - Code accuracy and specificity - ICD-10-CM structure and conventions - Chapter-specific guidelines |
| Healthcare Billing Fundamentals | 15-20% | - Healthcare documentation principles - Revenue cycle overview - Anatomy and physiology for billers - Medical terminology basics |
| Billing Compliance and Regulations | 10-15% | - Fraud, waste, and abuse prevention - Appeal and denial management - HIPAA privacy and security requirements - Documentation compliance - Stark Law and Anti-Kickback Statute basics |
| Insurance and Reimbursement | 20-25% | - Coordination of benefits - Commercial insurance policies - Claims submission and processing - Government payers (Medicare, Medicaid, TRICARE) - Workers' compensation and no-fault billing - Fee schedules and reimbursement methodologies |
| CPT Coding | 20-25% | - Modifiers and their appropriate use - CPT code categories and structure - Evaluation and Management (E/M) codes - Surgical procedure codes - Category II and III codes |
| Practice Management | 10-15% | - Insurance verification processes - Patient responsibility calculations - Patient registration and demographics - Accounts receivable management - Collections and payment posting |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. What is the primary purpose of National Correct Coding Initiative (NCCI) edits?
A) Replace CPT guidelines
B) Increase claim approvals
C) Set reimbursement rates
D) Identify unbundling and improper coding
2. What does it mean by dextr?
A) left
B) right
3. Case manager submits written confirmation, authorizing treatment, to provider.
A) TRUE
B) FALSE
4. What does the acronym E/M stand for in medical coding?
A) Electronic Medical Record
B) Evaluation and Management
C) Electronic Media Claim
D) Explanation of Benefits
5. HHRG stands for Home Health Resource Group.
A) TRUE
B) FALSE
Solutions:
| Question # 1 Answer: D | Question # 2 Answer: B | Question # 3 Answer: A | Question # 4 Answer: B | Question # 5 Answer: A |
