CPB Certified Professional Biller AAPC Exam Information

The Certified Professional Biller (CPB™) credential prepares medical billers with skills to maintain all aspects of the revenue cycle. Without expertise in medical billing and the nuances of payer requirements, reimbursement may be compromised.

VALIDATE YOUR EXPERTISE

Through rigorous examination and experience, certified CPB's have proven knowledge of how to submit claims in accordance with government regulations and private payer policies, follow-up on claim statuses, resolution of claim denials, appeals submission, posting of payments and adjustments, and collections management. The CPB medical billing certification is vital to the financial success of the professional services claims process.

Certified CPB's have demonstrated:

• Understanding of the various types of insurance plans
• Application of payer policy, Local Coverage Determinations (LCD), and National Coverage Determinations (NCD) for successful claim submissions
• Knowledge of CPT®, ICD-9-CM, and HCPCS Level II coding guidelines
• Successful navigation of the varying rules and regulations applying to the healthcare industry, including HIPAA, False Claims Act, Fair Debt Collections Act, and Stark
• Understanding of the life cycle of a medical billing claim and how to improve the revenue cycle
• Expertise in effective claim follow-up, patient follow-up, and denial resolution

The Certified Professional Biller (CPB™) credential prepares medical billers with skills to maintain all aspects of the revenue cycle. Without expertise in medical billing and the nuances of payer requirements, reimbursement may be compromised.

200 multiple choice questions (proctored)

5 hours and 40 minutes to finish the exam

1 free retake to be used within one year of first of attempt

$325 ($260 AAPC Students)

Open code book (manuals)

The CPB™ exam thoroughly covers: Types of insurance 44 questions

Managed care

Commercial payers

Medicare

Medigap

Medicaid

Blue Cross/Blue Shield

TRICARE/CHAMPUS

Worker’s compensation

Third party payers (automobile, liability, etc) Billing Regulations 25 questions

Accountable Care Organizations (ACO)

National Correct Coding Initiative (NCCI)

Local Coverage Determination (LCD)

National Coverage Determination (NCD)

Incident-to billing

Global packages

Unbundling

Completion of CMS1500

Completion of UB04e

Payer payment policies HIPAA & Compliance 10 questions

HIPAA privacy

Billing compliance

Medical record retention

Financial policies

Fraud and abuse Reimbursement & Collections 28 questions

RBRVS

Payer and patient refunds

Provider credentialing

Accounts receivable

Fair Debt

Patient statements

Patient dismissal

Professional courtesy

Collection agencies

Collections

Bankruptcy

Payment plans

Preauthorizations

Claim editing tools

Remittance advice Billing 28 questions

Appeals

Denials

Claims tracking and follow-up

Timely filing

Demographics

Superbill/encounter forms

Retention of records

Balance billing

Telephone courtesy

Electronic claim submission

Clean claims

Audit the billing process Coding 15 questions

CPT®

ICD-9-CM

HCPCS Level II

Modifiers Case Analysis In this section of the exam, source documents are provided for the examinee to review. Examinees will be provided with various policies and must be able to apply those policies.

Documents provided include:

50 questions

CMS 1500 claim forms

Remittance advices

Payment policies

Local Coverage Determinations (LCD)

National Coverage Determinations (NCD)

Appeal letters

Preauthorizations

Accounts receivable reports

Claims follow-up reports

Approved Manuals for Use During Examination

• CPT Books (AMA standard or professional edition ONLY). No other publisher is allowed
• Your choice of ICD-10-CM
• Your choice of HCPCS Level II

Note:

Any officially published errata for these manuals may also be used. No other manuals are allowed. Each code set is updated annually

;

it is essential that examinees use the current calendar year's coding manuals when taking the certification exam. Questions on the CPB™ tests do not require the use of any other outside material.

• We recommend having an associate’s degree.
• Pay examination fee at the time of application submission.
• Maintain current membership with the AAPC.
  • New members must submit membership payment with examination application.
  • Renewing members must have a current membership at the time of submission and when exam results are released.
• All exams will be reported with exact scores and areas of study (65% or less).

The Certified Professional Biller (CPB™) credential prepares medical billers with skills to maintain all aspects of the revenue cycle. Without expertise in medical billing and the nuances of payer requirements, reimbursement may be compromised.

VALIDATE YOUR EXPERTISE

Through rigorous examination and experience, certified CPB's have proven knowledge of how to submit claims in accordance with government regulations and private payer policies, follow-up on claim statuses, resolution of claim denials, appeals submission, posting of payments and adjustments, and collections management. The CPB medical billing certification is vital to the financial success of the professional services claims process.

Certified CPB's have demonstrated:

• Understanding of the various types of insurance plans
• Application of payer policy, Local Coverage Determinations (LCD), and National Coverage Determinations (NCD) for successful claim submissions
• Knowledge of CPT®, ICD-9-CM, and HCPCS Level II coding guidelines
• Successful navigation of the varying rules and regulations applying to the healthcare industry, including HIPAA, False Claims Act, Fair Debt Collections Act, and Stark
• Understanding of the life cycle of a medical billing claim and how to improve the revenue cycle
• Expertise in effective claim follow-up, patient follow-up, and denial resolution

The Certified Professional Biller (CPB™) credential prepares medical billers with skills to maintain all aspects of the revenue cycle. Without expertise in medical billing and the nuances of payer requirements, reimbursement may be compromised.

200 multiple choice questions (proctored)

5 hours and 40 minutes to finish the exam

1 free retake to be used within one year of first of attempt

$325 ($260 AAPC Students)

Open code book (manuals)

The CPB™ exam thoroughly covers: Types of insurance 44 questions

Managed care

Commercial payers

Medicare

Medigap

Medicaid

Blue Cross/Blue Shield

TRICARE/CHAMPUS

Worker’s compensation

Third party payers (automobile, liability, etc) Billing Regulations 25 questions

Accountable Care Organizations (ACO)

National Correct Coding Initiative (NCCI)

Local Coverage Determination (LCD)

National Coverage Determination (NCD)

Incident-to billing

Global packages

Unbundling

Completion of CMS1500

Completion of UB04e

Payer payment policies HIPAA & Compliance 10 questions

HIPAA privacy

Billing compliance

Medical record retention

Financial policies

Fraud and abuse Reimbursement & Collections 28 questions

RBRVS

Payer and patient refunds

Provider credentialing

Accounts receivable

Fair Debt

Patient statements

Patient dismissal

Professional courtesy

Collection agencies

Collections

Bankruptcy

Payment plans

Preauthorizations

Claim editing tools

Remittance advice Billing 28 questions

Appeals

Denials

Claims tracking and follow-up

Timely filing

Demographics

Superbill/encounter forms

Retention of records

Balance billing

Telephone courtesy

Electronic claim submission

Clean claims

Audit the billing process Coding 15 questions

CPT®

ICD-9-CM

HCPCS Level II

Modifiers Case Analysis In this section of the exam, source documents are provided for the examinee to review. Examinees will be provided with various policies and must be able to apply those policies.

Documents provided include:

50 questions

CMS 1500 claim forms

Remittance advices

Payment policies

Local Coverage Determinations (LCD)

National Coverage Determinations (NCD)

Appeal letters

Preauthorizations

Accounts receivable reports

Claims follow-up reports

Approved Manuals for Use During Examination

• CPT Books (AMA standard or professional edition ONLY). No other publisher is allowed
• Your choice of ICD-10-CM
• Your choice of HCPCS Level II

Note:

Any officially published errata for these manuals may also be used. No other manuals are allowed. Each code set is updated annually

it is essential that examinees use the current calendar year's coding manuals when taking the certification exam. Questions on the CPB™ tests do not require the use of any other outside material.

• We recommend having an associate’s degree.
• Pay examination fee at the time of application submission.
• Maintain current membership with the AAPC.
  • New members must submit membership payment with examination application.
  • Renewing members must have a current membership at the time of submission and when exam results are released.
• All exams will be reported with exact scores and areas of study (65% or less).