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Certified Professional Biller (CPB™)

CPB

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-10-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
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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
  • $380 ($300 AAPC Students) - one free retake
  • Open code book (manuals)

The CPB™ exam thoroughly covers:

  • 44 questions
  • Managed care
  • Commercial payers
  • Medicare
  • Medigap
  • Medicaid
  • Blue Cross/Blue Shield
  • TRICARE/CHAMPUS
  • Worker’s compensation
  • Third party payers (automobile, liability, etc)
  • 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 CMS-1500
  • Completion of UB-04
  • Payer payment policies
  • 10 questions
  • HIPAA privacy
  • Billing compliance
  • Medical record retention
  • Financial policies
  • Fraud and abuse
  • 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
  • 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
  • 15 questions
  • CPT®
  • ICD-10-CM
  • HCPCS Level II
  • Modifiers

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

Required References:

  • 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:

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 references cannot be used during the exam:

  • Any Procedural Coding Expert
  • Any Procedural Professional
  • CPT® Plus! - PMIC
  • CPT® Insider's View - AMA
  • ICD-10-CM Easy Coder
  • Study Guides
  • 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.

Note:

Each examination is separate and distinct from one another. To obtain all certifications, each examination must be taken separately and passed.

An overall score of 70% or higher is required to pass an exam. For examinees who do not pass, only the areas of study/categories with a score of 65% or less are provided for examinees’ preparation.

The areas of study reported reflect scores based on the number of questions in each category/section of the exam; each of the category/section may vary in the number of questions asked.

Continuing Education Unit (CEU) submissions are required for all certifications. For CEU requirements please see our CEU Information page.

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