Certified Professional Biller (CPB) - Certification Exam

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, healthcare provider reimbursement may be compromised.

Validate Your Expertise

Through rigorous examination and experience, CPBs have proven knowledge of how to submit claims compliant with government regulations and private payer policies. They follow up on claim statuses, resolve claim denials, submit appeals, post payments and adjustments, and manage collections. The CPB medical billing credential is vital to the financial success of the professional healthcare services claims process.

CPBs Earn Their Worth

According to AAPC's 2022 Salary Survey, medical billers with CPB certification average $55,078 in annual salary. If you want to see how much earning potential you have with medical billing expertise, can calculate the average CPB salary in your area, based on your job responsibility. Keep in mind that a CPB's annual salary varies based on the size of the practice you bill for or whether you work in a large facility. Other factors include years of experience, how many credentials held, and your location.

CPBs have demonstrated:

  • An understanding of various types of insurance plans
  • Expertise in applying payer policy, Local Coverage Determinations (LCDs), and National Coverage Determinations (NCDs) for successful claim submissions
  • Knowledge of CPT®, ICD-10-CM, and HCPCS Level II coding guidelines
  • Successful navigation of healthcare industry rules and regulations, including HIPAA, False Claims Act, Fair Debt Collections Act, and Stark Law.
  • An 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

The CPB Exam

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:

  • 29 questions
  • Managed care
  • Commercial payers
  • Medicare
  • Medigap
  • Medicaid
  • Blue Cross/Blue Shield
  • TRICARE/CHAMPUS
  • Worker's compensation
  • Third party payers (automobile, liability, etc.)
  • 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
  • 7 questions
  • HIPAA privacy
  • Billing compliance
  • Medical record retention
  • Financial policies
  • Fraud and abuse
  • 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
  • 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
  • 10 questions
  • CPT®
  • ICD-10-CM
  • HCPCS Level II
  • Modifiers
  • 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

Approved Code Books for Use During the CPB Exam

Because code sets are updated annually, it’s essential that you use the current calendar year's code books when taking the certification exam.

Any officially published errata for the above code books may also be used.

Confirm what reference materials are allowed during the CPB certification exam.

Exam Book Bundle 2022 (CPT®, HCPCS, ICD-10-CM)

AMA CPT® Professional 2022 - Now Shipping
HCPCS Level II Expert 2022 - Now Shipping
ICD-10-CM Complete Code Set 2022 - Now Shipping
Retail: $359.99   Save: $130.00 (36%)
Non-Member: $259.99
Member: $229.99

Exam Bundle includes the AMA CPT® Professional, ICD-10-CM Expert, and HCPCS Level II Expert — the three code books students need for nearly every AAPC exam, including AAPC’s Certified Professional Biller (CPB) exam.

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.

Medical Billing Certification Requirements

If you haven’t become an AAPC member, you must do so prior to scheduling your CPB exam. Renewing AAPC members are also required to have a current membership to sit for the CPB certification exam.

An overall score of 70% or higher is required to pass the certification exam.

  • If you don’t pass, the areas of study/categories with a score of 65% or less will be provided for your preparation to retest. The areas of study reported reflect scores based on the number of questions in each category/section of the exam.

All AAPC certification exams exclusively measure proficiencies relating to the one credential named in the exam. To earn additional medical coding credentials will require you to pass additional certification exams.

CEU Requirement: Certified coders are required to complete 36 Continuing Education Units (CEU's) every two years. For CEU requirements please see our CEU Information page.

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