Certified Professional Biller (CPB™)

The business of healthcare requires certified medical billers with skills to handle all aspects of the revenue cycle. Without expertise in medical billing and the nuances of payer requirements, reimbursement may be compromised. The Certified Professional Biller (CPB™) has proven by rigorous examination and experience that he or she knows how to submit claims in accordance with government regulations and private payer policies, follow-up on claim statuses, resolve claim denials, submit appeals, post payments and adjustments, and manage collections. CPB™ medical billing certification is vital to the financial success of the professional services claims process.

The CPB's medical billing abilities include:

  • Understanding different types of insurance plans
  • Applying payer policy, Local Coverage Determinations (LCD), and National Coverage Determinations (NCD) for successful claim submission
  • Knowing CPT®, ICD-9-CM, and HCPCS Level II coding guidelines
  • Navigating the varying rules and regulations which apply to the healthcare industry, including HIPAA, False Claims Act, Fair Debt Collections Act, and Stark
  • Knowing 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

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The CPB™ Exam

  • 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
  • $300 ($260.00 AAPC Student)
  • 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-9-CM
  • Your choice of HCPCS Level II

Note:
Electronic devices with an on/off switch (cell phones, smart phones, tablets, etc.) are not allowed into the examination room. Failure to comply with this policy may result in disqualification of your exam.

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.

Approved Exam Manuals

Non-Approved Manuals for Use During Examination

Due to the advantages of additional information and/or ease of use, the following books cannot be used during the exam:

  • Current Procedural Coding Expert® - Ingenix
  • Procedural Coding Professional - Contexo
  • Procedural Coding Professional - AAPC
  • Procedural Coding Expert - Contexo
  • Procedural Coding Expert - AAPC
  • CPT® Insider's View - AMA
  • CPT® Plus! - PMIC
  • Coders' Choice CPT® - PMIC
  • ICD-9-CM Easy Coder - Unicor
  • 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).

Note:
Each examination is separate and distinct. To obtain all certifications, each examination must be taken separately and passed. Continuing Education Unit (CEU) submissions are required for all certifications. For CEU requirements please see our CEU Information page.