Certified Professional Biller (CPB) Practice Exam

The Certified Professional Biller (CPB) certification from AAPC is designed to validate a professional’s ability to handle medical billing processes in healthcare settings. This certification focuses on the knowledge and skills required to manage patient data, coding, insurance claims, billing processes, and compliance with healthcare regulations. A CPB-certified individual is proficient in the accurate submission of claims, understanding medical codes, insurance procedures, and working with payers, ensuring that healthcare providers are reimbursed appropriately for services rendered. The certification is widely recognized in the medical billing field and is essential for those seeking to build a career in medical billing and coding.
Why is Certified Professional Biller (CPB) important?

• Establishes proficiency in medical billing, including claims submission and follow-up.
• Validates knowledge of healthcare insurance policies, coding procedures, and billing regulations.
• Enhances job prospects in the healthcare and medical billing industry.
• Ensures compliance with federal and state healthcare regulations and payer policies.
• Improves accuracy in claim submissions, leading to fewer denials and faster reimbursements.
• Demonstrates professionalism and credibility in the medical billing field.
• Provides career advancement opportunities within healthcare administration.

Who should take the Certified Professional Biller (CPB) Exam?

• Medical Biller
• Medical Billing Specialist
• Medical Office Administrator
• Healthcare Billing Coordinator
• Billing Manager
• Insurance Billing Specialist
• Revenue Cycle Specialist
• Health Insurance Claims Specialist
• Patient Accounts Representative
• Medical Claims Processor

Skills Evaluated

Candidates taking the certification exam on the Certified Professional Biller (CPB) is evaluated for the following skills:

• Knowledge of the medical billing process, including the submission of claims to insurers.
• Proficiency in using medical billing codes, such as ICD-10, CPT, and HCPCS.
• Understanding of insurance verification, authorization, and payer-specific requirements.
• Familiarity with medical billing software and electronic health records (EHR).
• Ability to process and appeal denied claims.
• Understanding of compliance regulations, such as HIPAA, and how they apply to billing practices.
• Strong attention to detail for accurate claim submission and follow-up.

Certified Professional Biller (CPB) Certification Course Outline
The Certified Professional Biller (CPB) Certification covers the following topics -

Module 1. Types of Insurance

• Managed care

• Commercial payers

• Medicare

• Medigap

• Medicaid

• Blue Cross/Blue Shield

• TRICARE/CHAMPUS

• Worker’s compensation

• Third party payers (automobile, liability, etc.)

Module 2. Billing Regulations

• 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

Module 3. HIPAA & Compliance

• HIPAA privacy

• Billing compliance

• Medical record retention

• Financial policies

• Fraud and abuse

Module 4. Reimbursement and Collections

• RBRVS

• Payer and patient refunds

• Provider credentialing

• Accounts receivable

• Fair Debt

• Patient statements

• Patient dismissal

• Professional courtesy

• Collection agencies

• Collections

• Bankruptcy

• Payment plans

• Pre-authorizations

• Claim editing tools

• Remittance advice

Module 5. Billing

• 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

Module 6. Coding

• CPT®

• ICD-10-CM

• HCPCS Level II

• Modifiers

Module 7. Case Analysis