Certified Professional Biller (CPB)® Certification
The Certified Professional Biller (CPB) credential demonstrates skills related to maintaining all aspects of the revenue cycle, particularly patient and payer billing and collections. Without expertise in medical billing and the nuances of payer requirements, healthcare provider reimbursement may be compromised.
Certified Professional Biller (CPB)® certification
Exam format
135 multiple-choice questions
Online or in-person options
AAPC offers online and in-person proctored exams. Choose to take the exam at home in a quiet, private location or through your local chapter or a licensed instructor. Learn more about the online proctored exam and how to prepare for the current exam.
Time allowed
In-person and online exams are administered in one sitting, with four hours to complete the exam.
Equipment required for online exam
A reliable internet connection and an external webcam that can be positioned to show your face, hands, keyboard, and the area around the keyboard (about 10 inches) are required.
Experience Requirements
High-level knowledge of medical terminology, anatomy, and pathophysiology, along with an understanding of the proper application of payer policies; compliance rules; healthcare regulations; CPT® procedure codes, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis codes.
Approved code books
AMA’s CPT® Professional Edition, as well as your choice of ICD-10-CM and HCPCS Level II code books.
Maintaining your certification
To maintain your credential, you must maintain your AAPC annual membership, and earn 36 continuing education units (CEUs) every two years.
The CPB Exam Pattern
The CPB Exam is a rigorous, 135 multiple choice exam. Students are given 4 hours to finish the exam with approved code books. Your chances of passing the CPB exam are highest when you’ve chosen to do your training through AAPC.
· 135 multiple choice questions (proctored)
· 4 hours to finish the exam
· Open code book (manuals)
The CPB exam thoroughly covers:
Types of Insurance
· 29 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
· 17 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 CMS-1500
· Completion of UB-04
· Payer payment policies
HIPAA & Compliance
· 7 questions
· HIPAA privacy
· Billing compliance
· Medical record retention
· Financial policies
· Fraud and abuse
Reimbursement & Collections
· 19 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
· 19 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
· 10 questions
· CPT®
· ICD-10-CM
· HCPCS Level II
· Modifiers
Documentation
· 34 questions
· 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:
· 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
Case Analysis
34 questions
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:
· 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
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