The CPB (Certified Professional Biller) Certification shows skills related to maintaining all features of the Revenue Cycle Management, Specifically Patient and US Healthcare Insurance Medical Billing, Payment Collections & Account Receivables. Without expertise in medical billing and the nuances of payer requirements, healthcare provider reimbursement may be compromised.
Through difficult examination and experience, CPBs have proven knowledge of how to submit Claims compliant with Commercial Payer & US Government Regulations, Guidelines and payer specific policies. They follow up on Claim status, can work of Rejection & Claim Denials, submit appeals, Enter Charges posting & Insurance Payment Posting with adjustments, Patient Statements and manage collections. The CPB medical billing credential is energetic to the financial success of the professional US healthcare services claims process.
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
Course Features
- Lectures 0
- Quizzes 7
- Duration 24 weeks
- Skill level Intermediate
- Language English
- Students 1
- Assessments Self
