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AAPC CPB Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Topic 1: Coding and Claim Submission Basics | - Claims submission processes - Use of modifiers and coding compliance - ICD-10-CM, CPT, and HCPCS overview |
| Topic 2: Medical Billing Fundamentals | - Healthcare reimbursement systems - Insurance types and payer structures - Medical billing workflow and revenue cycle |
| Topic 3: Revenue Cycle Management | - Claims denial and rejection management - Payment posting and reconciliation - Accounts receivable follow-up |
| Topic 4: Insurance Processing and Payer Rules | - Private insurance policies and contracts - Medicare and Medicaid guidelines - Coordination of benefits (COB) |
| Topic 5: Compliance and Regulations | - Fraud and abuse prevention - HIPAA and patient privacy rules - Billing compliance standards |
AAPC Certified Professional Biller (CPB) Sample Questions:
1. Billing entity is the legal business name of the provider's practice.
A) TRUE
B) FALSE
2. What does HMO stand for?
A) Hospital Monitoring Organization
B) Health Management Organization
C) Hospital Management Organization
D) Health Maintenance Organization
3. Which situation is considered billing fraud?
A) Typographical error on a claim
B) Appealing a denied claim
C) Late claim submission
D) Billing for services not rendered
4. Blue Worldwide Expat __________
A) provides global medical coverage for active employees and their dependents who spend more than three months outside the United States for three months or more is eligible for Blue World Expat.
B) provides global medical coverage for active employees and their dependents who spend more than six months outside the United States for six months or more is eligible for Blue World Expat.
C) provides global medical coverage for active employees and their dependents who spend more than six months outside the United States for three months or more is eligible for Blue World Expat.
D) provides global medical coverage for active employees and their dependents who spend more than three months outside the United States for six months or more is eligible for Blue World Expat.
5. Birthday rule determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
A) TRUE
B) FALSE
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: D | Question # 3 Answer: D | Question # 4 Answer: B | Question # 5 Answer: A |


