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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).
