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Exam Information
Official specifications published by AAPC
Exam Format
240 min
135
70%
Professional
Registration
$399 USD
Meazure Learning or online proctoring
Validity
2 years
Earn 36 CEUs every 2 years; Maintain active AAPC membership
CPB Exam Topics and Domains
CPB is organized into 7 weighted domains. Expect to work with CMS, Clearinghouses, Commercial payers, Compliance programs, and more.
1
Types of Insurance
21.5%
Government Insurance Programs
MedicareMedicaidTRICARE
- Identify the components and coverage of Medicare Parts A, B, C, and D
- Determine when Medicare is primary or secondary payer
- Understand state-specific Medicaid requirements and dual eligibility
- Distinguish between TRICARE Prime, Select, and For Life programs
Commercial Insurance and Managed Care
Managed Care PlansBlue Cross Blue Shield
- Compare and contrast managed care plan types (HMO, PPO, EPO, POS)
- Identify when referrals and authorizations are required
- Understand BlueCard program functionality
Other Insurance Types
Workers' CompensationThird-Party Liability
- Identify workers' compensation billing requirements
- Understand third-party liability coordination of benefits
- Recognize when alternative payers are primary
2
Billing Regulations
12.6%
Coding Compliance and Edits
NCCI EditsCoverage Determinations
- Apply NCCI edits to code combinations
- Distinguish between LCDs and NCDs
- Determine when ABNs are required
Billing Guidelines and Forms
Global Surgical PackagesIncident-to BillingCMS-1500 and UB-04 Forms
- Identify services included in global surgical packages
- Apply incident-to billing criteria
- Complete CMS-1500 and UB-04 forms accurately
- Understand unbundling and upcoding prohibitions
Accountable Care Organizations
ACO Models
Understand ACO payment models and structures
3
HIPAA and Compliance
5.2%
HIPAA Regulations
Privacy RuleSecurity RuleTransaction and Code Sets
- Identify when PHI disclosures require patient authorization
- Apply minimum necessary standard
- Understand HIPAA Security Rule safeguards
- Recognize breach notification requirements
Fraud, Waste, and Abuse
Compliance ProgramsFraud and Abuse Laws
- Identify the seven elements of compliance programs
- Recognize violations of False Claims Act, Anti-Kickback Statute, and Stark Law
- Understand penalties for fraud and abuse
4
Reimbursement and Collections
14.1%
Reimbursement Methodologies
Payment SystemsProvider Credentialing and Contracting
- Calculate payments using RBRVS methodology
- Distinguish between payment methodologies (FFS, DRG, APC, capitation)
- Understand provider credentialing process
Revenue Cycle Management
Accounts ReceivableCollectionsRefunds
- Calculate revenue cycle KPIs (days in A/R, collection rate)
- Apply FDCPA in collection activities
- Manage patient and payer refunds
- Interpret A/R aging reports
Denials and Appeals
Denial ManagementAppeals Process
- Identify common denial reasons and resolutions
- Navigate Medicare appeals process
- Write effective appeal letters
- Track and trend denials for process improvement
5
Claims and Billing
14.1%
Claims Processing
Electronic Claims SubmissionPaper Claims
- Distinguish between claim rejections and denials
- Understand electronic claims submission process
- Identify when paper claims are appropriate
Claim Management
Timely Filing and Clean ClaimsClaim Status and Tracking
- Apply timely filing requirements by payer
- Define clean claim criteria
- Use claim status inquiry transactions
- Interpret remittance advice and EOBs
Secondary Billing and Coordination of Benefits
Coordination of BenefitsBalance Billing
- Determine primary vs secondary payer using COB rules
- Apply birthday rule correctly
- Understand balance billing regulations
- Submit secondary claims appropriately
Patient Registration and Verification
Demographics and RegistrationPreauthorization and Precertification
- Collect complete patient demographics
- Verify insurance eligibility electronically
- Obtain required prior authorizations
- Complete encounter forms accurately
6
Coding
7.4%
Procedural Coding
CPT CodingHCPCS Level II Coding
- Select appropriate CPT and HCPCS codes from documentation
- Apply CPT and HCPCS modifiers correctly
- Understand E/M code selection
Diagnosis Coding
ICD-10-CMCode Linkage
- Select ICD-10-CM codes to highest specificity
- Apply diagnosis sequencing rules
- Link diagnoses to procedures appropriately
- Support medical necessity with coding
7
Case Analysis
25.2%
Source Document Review
Medical Record AnalysisPolicy Application
- Abstract billable services from medical records
- Apply payer policies to clinical scenarios
- Assess documentation adequacy for billing
Scenario-Based Problem Solving
Complete Billing ScenariosDenial Resolution Cases
- Solve multi-step billing scenarios
- Analyze and resolve claim denials
- Apply policies to real-world cases
- Make appropriate billing decisions
Complex Billing Situations
Multiple Insurance ScenariosCompliance ScenariosForms Completion Cases
- Handle multiple insurance coordination scenarios
- Apply compliance requirements to situations
- Complete claim forms from complex scenarios
- Make ethical billing decisions
How do I earn this certification?
Passing CPB earns the CPB certification. It sits in the Medical Billing and Coding track.
Alternative Paths
- Certified Revenue Cycle Representative (CRCR)
- Certified Healthcare Billing and Management Executive (CHBME)
Practice with Precision
The PlanetCert Simulator mirrors the real exam environment with authentic questions and timed pressure.
How to study for this exam?
Use the official PlanetCert Practice Test alongside the study plan below to prepare efficiently for CPB.
What's changed on this exam?
Current Status
- ACTIVE
- Last content update: 2024-01-01
Updates
- Electronic Claims Submission (EDI) 5010 and NCPDP D.0 Current EDI transaction standards (837, 835, 276, 277) remain core exam content • Release date: Ongoing standard
- ICD-10-CM Annual Updates Updated annually October 1 Exam uses current year code sets; candidates should use current year books • Release date: 2024-10-01
- CPT Code Updates Updated annually January 1 Current year CPT codes required for exam; annual updates reflect latest procedures • Release date: 2025-01-01
Who should take this exam?
This exam is typically taken by Medical billers seeking professional certification and Revenue cycle staff looking to advance.
- 2+ years professional medical billing experience
- High-level knowledge of medical terminology, anatomy, and pathophysiology
- Understanding of CPT, ICD-10-CM, and HCPCS Level II codes
- Familiarity with payer policies and healthcare regulations