Smiling medical billing coder in front of a laptop

How to Pass the CPB Exam

Everything you need to know about the Certified Professional Biller (CPB) exam

Smiling medical billing coder in front of a laptop

In the intricate realm of healthcare finances, the Certified Professional Biller (CPB) shines as a guardian of accuracy, compliance, and financial success. With their deep understanding of medical billing and coding, CPBs serve as the gatekeepers of revenue integrity in healthcare organizations. They possess a wealth of knowledge in coding systems, reimbursement methodologies, and healthcare regulations, ensuring that claims are processed accurately and efficiently. Through their expertise, CPBs navigate the complexities of insurance plans, advocate for fair reimbursement, and protect against fraud and abuse. Their meticulous attention to detail and commitment to staying abreast of ever-changing guidelines make them vital contributors to the financial well-being of healthcare institutions. The CPB certification symbolizes excellence, professionalism, and a steadfast dedication to ensuring that healthcare providers are reimbursed fairly, allowing them to continue their noble mission of providing quality care to those in need.

In this article, we’ll cover various aspects of the Certified Professional Biller (CPB) Exam, including eligibility criteria, how to register for the exam, tips on how to study effectively, along with highlights of the subjects and procedures covered in the CPB exam. Additionally, we’ll explore educational and training options available to prepare for the CPB exam and the process for renewing the CPB certification.

Read how to become a Medical Office Administrator if you want to learn more about the responsibilities, educational requirements, job outlook, and salary* of medical administrators.

What is the CPB Exam?

How Long is the CPB Exam and What Does it Cost?

The Certified Professional Biller (CPB) Exam is a professional certification exam offered by the American Academy of Professional Coders (AAPC). The CPB credential is designed for individuals who work in the field of medical billing and serves as a validation of their knowledge and expertise in this area.

The CPB exam assesses the candidate’s proficiency in various aspects of medical billing, including healthcare regulations, reimbursement methodologies, claims processing, coding concepts, and compliance. It covers topics such as medical terminology, anatomy, medical coding systems (e.g., CPT, HCPCS, ICD-10-CM), insurance plans, billing documentation, and revenue cycle management.

Typically, the exam consists of 200 multiple-choice questions and must be completed within a given time frame, usually around 5 hours. The exam fee is $260.00 for AAPC members or $300.00 for non-members. It’s advisable to check with the AAPC for the specific cost details.

CPB Exam Eligibility

To be eligible to take the Certified Professional Biller (CPB) Exam offered by the American Academy of Professional Coders (AAPC), you need to meet certain criteria. The eligibility requirements for the CPB exam are as follows:

  • Education: There are no specific education requirements to be eligible for the CPB exam. However, having a high school diploma or equivalent is recommended.
  • Experience: You must have at least two years of professional experience in medical billing or a related field. This experience should involve tasks such as claims processing, reimbursement, coding, or billing documentation. The AAPC accepts experience obtained through employment, externship, or apprenticeship.
  • Membership: AAPC membership is not mandatory for taking the CPB exam, but it is highly recommended. Becoming a member of the AAPC provides access to additional resources, networking opportunities, and ongoing education.

It’s important to note that meeting the eligibility requirements alone does not grant you the CPB certification. Successfully passing the exam is necessary to obtain the CPB credential. Before registering for the CPB exam, carefully review the AAPC’s official guidelines and requirements to ensure you meet the necessary qualifications.

How Do I Register for the CPB Exam?

To register for the Certified Professional Biller (CPB) Exam offered by the American Academy of Professional Coders (AAPC), you can follow these steps:

  1. Create an AAPC Account: If you don’t already have an account with the AAPC, visit their official website and create a new account. This will provide you with access to their exam registration system.
  2. Select the Exam: Once you have an AAPC account, log in to their website and navigate to the “Certification” section. Locate the CPB Exam and select it as the exam you wish to register for.
  3. Review Exam Eligibility: Ensure that you meet the eligibility requirements for the CPB exam, including the necessary education and experience criteria.
  4. Schedule the Exam: Choose a suitable date, time, and location for your CPB exam. The AAPC offers various options for exam centers and online proctoring.
  5. Pay the Exam Fees: The CPB exam has associated fees that need to be paid during the registration process. The exact cost can be found on the AAPC website or by contacting the AAPC directly. Make the required payment to complete the registration.
  6. Prepare for the Exam: Once registered, you can start preparing for the CPB exam. The AAPC provides study materials, including official manuals and practice exams. Use these resources to review and reinforce your knowledge of medical billing.

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How Do I Study to Pass the CPB Exam?

Sample Multiple Choice Questions You Might Find on the Exam

Studying for the Certified Professional Biller (CPB) Exam requires a focused and comprehensive approach to cover the necessary knowledge and skills. Here are some steps you can follow to effectively study for the CPB exam:

  1. Review the Exam Content Outline: Familiarize yourself with the CPB exam content outline provided by the AAPC. This outline highlights the topics and domains that will be covered in the exam. Use it as a guide to structure your study plan.
  2. Obtain Official Study Materials: The AAPC offers official study materials, including manuals and workbooks, specifically designed for the CPB exam. These resources provide comprehensive coverage of the exam content and are highly recommended for studying.
  3. Understand Medical Billing Concepts: Ensure you have a solid understanding of medical billing concepts, terminology, and processes. Review topics such as claims processing, reimbursement methodologies, coding systems (CPT, HCPCS, ICD-10-CM), documentation requirements, compliance regulations, and revenue cycle management.
  4. Practice Coding and Billing Scenarios: Familiarize yourself with coding and billing scenarios commonly encountered in medical billing. Consider using case studies, practice exercises, and coding/billing simulations to enhance your skills.
  5. Utilize Practice Exams: The AAPC offers practice exams specifically tailored for the CPB exam. Take these practice exams to gauge your knowledge, identify weak areas, and become familiar with the exam format and question types.
  6. Join Study Groups or Online Forums: Engage with fellow CPB exam candidates or professionals in the field through study groups or online forums. Participating in discussions and sharing study strategies can provide valuable insights, clarification on concepts, and additional resources.
  7. Take Advantage of AAPC Resources: The AAPC provides additional resources, such as webinars, workshops, and coding/billing conferences. Take advantage of these opportunities to expand your knowledge, stay updated with industry changes, and interact with experts in the field.
  8. Establish a Study Schedule: Develop a study schedule that suits your learning style and availability. Break down the exam content into manageable study sessions and allocate sufficient time for each topic.

Remember to stay organized, set realistic goals, and maintain a disciplined study routine. With proper preparation and dedication, you can increase your chances of success in the CPB exam. Here are several sample multiple-choice questions that you might find on the Certified Professional Biller (CPB) Exam:

1. Which of the following coding systems is used to report medical procedures and services?

  • a) ICD-10-CM
  • b) CPT
  • c) HCPCS
  • d) DSM-5

2. What is the purpose of the Explanation of Benefits (EOB) statement?

  • a) To inform the patient about their insurance coverage details
  • b) To notify the provider of claim denial or rejection
  • c) To provide a summary of the medical services rendered
  • d) To request additional information from the provider

3. Which of the following is an example of a remittance advice code indicating partial payment of a claim?

  • a) CO-16
  • b) PR-1
  • c) CO-45
  • d) OA-23

4. When submitting an insurance claim electronically, which transaction would typically be used to send a claim to the payer?

  • a) HIPAA 270/271
  • b) HIPAA 278
  • c) HIPAA 837
  • d) HIPAA 835

5. Which of the following is an example of a healthcare fraud and abuse offense?

  • a) Billing for services not provided
  • b) Accurate coding and documentation
  • c) Timely claim submission
  • d) Following proper privacy protocols

Please note that these questions are for illustrative purposes only and may not reflect the exact questions you will encounter on the CPB Exam. The actual exam questions may cover a broader range of topics related to medical billing, coding, regulations, and reimbursement methodologies.

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What is the Passing Score?

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. By thoroughly studying the exam content, practicing with sample questions, and adequately preparing, you can increase your chances of passing the CPB Exam and earning the Certified Professional Biller credential.

Subjects and Procedures Covered in the CPB Exam

The Certified Professional Biller (CPB) Exam covers a range of subjects and procedures related to medical billing. The exam is designed to assess the candidate’s knowledge and proficiency in various areas of medical billing, coding, reimbursement, and compliance. While the specific content may vary, the following subjects and procedures are typically covered in the CPB Exam:

  1. Healthcare Regulations and Compliance
    • HIPAA regulations
    • Fraud and abuse laws
    • Compliance programs
    • Privacy and security rules
  1. Medical Billing Concepts and Processes
    • Revenue cycle management
    • Claims processing
    • Charge capture and coding
    • Billing and collections
    • Denials management
    • Refunds and appeals
  1. Coding Systems
    • Current Procedural Terminology (CPT)
    • Healthcare Common Procedure Coding System (HCPCS)
    • International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM)
  1. Reimbursement Methodologies
    • Fee-for-service
    • Resource-Based Relative Value Scale (RBRVS)
    • Prospective Payment Systems (PPS)
    • Medicare and Medicaid reimbursement guidelines
    • Commercial insurance reimbursement policies
  1. Documentation Requirements
    • Medical record documentation guidelines
    • Documentation for accurate coding and billing
    • Documentation standards for different types of services and procedures
  1. Insurance Plans and Payers
    • Medicare
    • Medicaid
    • Commercial insurance plans
    • Managed care organizations
    • Coordination of benefits
  1. Claim Submission and Processing
    • Electronic claims submission
    • Paper claims submission
    • Claim edits and validation
    • Claim status and remittance advice
  1. Medical Terminology and Anatomy
    • Understanding medical terms and abbreviations
    • Basic knowledge of human anatomy and physiology

It’s important to note that the exam content may be updated periodically, so it’s recommended to refer to the official materials and exam content outline provided by the American Academy of Professional Coders (AAPC) for the most accurate and up-to-date information on the subjects and procedures covered in the CPB Exam.

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Educational and Training Options to Prepare for the CPB Exam

To prepare for the Certified Professional Biller (CPB) Exam, there are various educational and training options available. Combine multiple educational and training options based on your learning style and preferences to maximize your exam preparation. Here are some options you can consider:

  • Official AAPC Study Materials: The American Academy of Professional Coders (AAPC) offers official study materials specifically designed for the CPB Exam. These materials include study guides, workbooks, and practice exams that align with the exam content.
  • Online Courses: Many online platforms offer CPB exam preparation courses. These courses are designed to cover the exam content in a structured manner, providing video lectures, interactive exercises, and practice exams.
  • Local Colleges and Universities: Check if local colleges or universities offer courses or certificate programs in medical billing and coding. They may provide classroom instruction, hands-on training, and opportunities to interact with industry professionals.
  • Continuing Education Events and Webinars: The AAPC and other professional organizations often host webinars, conferences, and continuing education events focused on medical billing and coding. Consider attending relevant events to enhance your knowledge and stay current with industry practices.
  • Self-Study with Textbooks and Resources: Utilize textbooks and study guides that cover medical billing and coding concepts. Look for reputable resources recommended by professionals in the field. These resources can provide in-depth explanations, examples, and practice questions to help you understand and apply the concepts required for the CPB Exam.
  • Practice Exams and Sample Questions: AAPC provides practice exams that closely mimic the actual exam format and question types. Solving these practice questions will familiarize you with the exam style, improve your test-taking skills, and identify areas that require further study.

How Many Times Can You Take the CPB Exam?

There is no specific limit to the number of times you can take the Certified Professional Biller (CPB) Exam. If you do not pass the exam on your first attempt, you are allowed to retake it. However, keep in mind that there may be certain requirements and restrictions that vary depending on the certifying organization, such as waiting periods between exam attempts or additional fees for retaking the exam.

Consult the specific guidelines and policies of the certifying organization, in this case, the American Academy of Professional Coders (AAPC), for accurate and up-to-date information on retaking the CPB Exam. They will provide you with the most accurate details regarding any waiting periods, fees, or other requirements for exam retakes.

Renewing Certified CPB Certification

To renew your Certified Professional Biller (CPB) certification, you need to fulfill certain requirements set by the certifying organization. Here are the general steps to renew your CPB certification:

  • Earn Continuing Education Units (CEUs): To maintain your CPB certification, you must accumulate a certain number of CEUs within a specific renewal period. CEUs are earned by participating in educational activities, such as attending workshops, webinars, and conferences, or completing online courses relevant to medical billing and coding. The AAPC assigns a specific value to each activity in terms of CEUs.
  • Complete the Required CEU Hours: The AAPC mandates a certain number of CEUs to be completed within a specific time frame, usually two years, to be eligible for certification renewal. For example, as of my knowledge cutoff in September 2021, CPB certification renewal requires 36 CEUs over two years.
  • Submit CEU Documentation: Gather documentation for the educational activities you have completed, including certificates of attendance or completion. The AAPC provides an online portal where you can submit your CEU documentation for review and verification.
  • Pay the Renewal Fee: Along with the CEU documentation, you will be required to pay a renewal fee to maintain your CPB certification. The fee amount is determined by the AAPC and may vary over time. Ensure that you submit the fee payment along with your CEU documentation.
  • Stay Updated with Current Guidelines: It’s essential to stay informed about any changes in the renewal requirements and guidelines provided by the AAPC. Regularly check their website, communications, or contact the AAPC directly for the most up-to-date information regarding CPB certification renewal.

Smiling medical professional holding a tablet

It’s crucial to stay proactive and plan your continuing education activities in advance to ensure a smooth renewal process.

Learn more on how to become a Medical Office Administrator and explore educational programs, such as the Medical Office Administration program at Brookline College to gain the relevant skills and knowledge to pursue a career in dental assisting. In addition, check out the best entry-level medical jobs to see all the available options for a career in the healthcare profession.