Taking the CPB^® exam

The CPB exam is a test of medical billing proficiency consisting of 135 multiple-choice questions that assess several areas of knowledge. The questions require an understanding of the types of insurance plans; local and national coverage determinations (LCDs and NCDs); healthcare regulations such as HIPAA, the False Claims Act, the Fair Debt Collections Act, and Stark Law; the life cycle of a medical claim; denial resolution; medical coding; and more.

Who should take the CPB exam?

After you’ve trained with AAPC to become a medical biller — or if you have substantial medical billing experience — you should take the opportunity to gain certification by registering for the CPB exam.

What to expect on exam day

The exam has a total of 135 questions to be answered in four hours. People often wonder if the CPB exam is hard. We'll say this: If you have taken the training course, studied, and are familiar with your CPT^®, ICD-10-CM, and HCPCS Level II code books, the test will be demanding, but not difficult.

Here's a quick overview of what you can expect:

Before you begin the test, take a moment, and breathe. You have prepared for this. You have your code books by your side and know how to use them. This is your opportunity to demonstrate your billing expertise.

You'll have 4 hours to finish the exam, giving you approximately 1.7 minutes to answer each of the 135 multiple-choice questions. You can save time by reading the answer choices before reading each question and by saving the more difficult questions for last. It’s important to answer every question, even if you aren’t sure. Your best guess is better than no answer at all.

The questions assess several areas of knowledge, many of which are presented as scenarios to test application of knowledge about types of insurance plans; local and national coverage determinations (LCDs and NCDs); healthcare regulations such as HIPAA, the False Claims Act, the Fair Debt Collections Act, and Stark Law; the life cycle of a medical claim; denial resolution; medical coding; and more. The exam includes 34 cases that test the ability to read and apply policies. Source documents are provided for the examinee to review.

You will be able to reference approved medical code books during the exam — the AMA's CPT^® Professional Edition, as well as your choice of ICD-10-CM and HCPCS Level II code books. To be clear, these are the only code books you are allowed to use.

Passing grades

An overall score of 70% or higher is required to pass the certification exam. For a passing score of 70%, you must get at least 95 questions correct. If you incorrectly answer more than 41 questions, you will not pass. If you don’t pass, you will be notified of the categories/areas of study with sub-scores of 65% or less to help you prepare for retesting.

All AAPC certification exams exclusively measure proficiencies relating to the one credential named in the exam. To earn additional credentials, you will be required to pass additional certification exams.

Your results will be shared with you online in your Account Dashboard under Courses and Exams. You can expect the results within 7-10 business days after taking the exam. Once you have passed, your certificate will be sent to you in the mail.

Materials allowed on the day of the exam

Breakdown of the 135-question CPB exam

Passing the CPB exam requires you to correctly answer a minimum of 95 questions from the domains below. The CPB test will rely on a level of understanding that enables you to identify the domain.

Types of insurance (29 questions)
These questions will assess your knowledge of managed care, commercial payers, Medicare, Medigap, Medicaid, Blue Cross/Blue Shield, TRICARE/CHAMPUS, workers’ compensation, and third-party payers (automobile, liability, etc.).

Billing regulations (17 questions)
These questions will address accountable care organizations (ACOs), the National Correct Coding Initiative (NCCI), local coverage determinizations (LCDs), national coverage determinations (NCDs), incident-to billing, global packages, unbundling, completion of the CMS-1500 and UB-04 forms, and payer payment policies.

HIPAA and compliance (7 questions)
This section will test your knowledge of HIPAA privacy, billing compliance, medical record retention, financial policies, and fraud and abuse.

Reimbursement and collections (19 questions)
This section will address 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, and remittance advice.

Claims and billing (19 questions)
This section will test your knowledge on 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, and auditing the billing process.

Coding (10 questions)
This section will assess your knowledge on CPT®, ICD-10-CM, and HCPCS Level II codes and modifiers.

Case analysis (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

• Payment policies

• Local coverage determinations (LCD)

• National coverage determinations (NCD)

• Appeal letters

• Preauthorizations

• Accounts receivable reports

• Claims follow-up reports