Exam Name: Certified Professional Biller (CPB)
Certification Provider: AAPC
Corresponding Certification: AAPC Certification
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Updated: Sep 15, 2026
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AAPC CPB Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Coding and Claim Submission Basics | - Claims submission processes - ICD-10-CM, CPT, and HCPCS overview - Use of modifiers and coding compliance |
| Medical Billing Fundamentals | - Medical billing workflow and revenue cycle - Healthcare reimbursement systems - Insurance types and payer structures |
| Compliance and Regulations | - HIPAA and patient privacy rules - Billing compliance standards - Fraud and abuse prevention |
| Revenue Cycle Management | - Accounts receivable follow-up - Payment posting and reconciliation - Claims denial and rejection management |
| Insurance Processing and Payer Rules | - Medicare and Medicaid guidelines - Private insurance policies and contracts - Coordination of benefits (COB) |
AAPC Certified Professional Biller (CPB) Sample Questions:
What are actions inconsistent with accepted, sound medical business or fiscal practice?
- A. Abuse
- B. Violence
- C. Neglect
- D. Addiction
Correct Answer: A 🗳️
What is All Patient Refined DiagnosisRelated Group (ARPDRG)?
- A. DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to nonMedicare beneficiaries (e.g. Blue Cross BlueShield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources.
- B. Adopted by Medicare in 2008 to reimburse hospitals for inpatient care provided to Medicare beneficiaries; expanded original DRG system (based on intensity of resources) to add two subclasses to each DRG that adjusts Medicare inpatient hospital reimbursement rates for severity of illness (SOI) (extent of physiological decompensation or organ system loss of function) and risk of mortality (ROM) (likelihood of dying); each subclass, in turn, is subdivided into four areas: (1) minor, (2) moderate, (3) major, (4) extreme.
Correct Answer: B 🗳️
Case mix includes the types and categories of patients treated by a healthcare provider.
- A. FALSE
- B. TRUE
Correct Answer: B 🗳️
EOB
- A. Explanation of Benefits
- B. Early and Periodic screening, diagnostic, and treatment
- C. Exclusive provider organization
- D. External Quality Review Organization
Correct Answer: A 🗳️
What does the acronym DSM stand for?
- A. Electronic funds transfer
- B. Electronic data interchange
- C. Diagnostic and statistical manual
- D. (California) Employment Development Department
Correct Answer: C 🗳️
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