2026 CPB Study Guide Certified
Professional Biller Exam Prep Practice
Questions Answer Explanations • Medical
Billing • Claims • Reimbursement •
Insurance • Compliance Review
1. What does CMS stand for?
• A) Certified Medical System
• B) Centers for Medicare & Medicaid Services
• C) Clinical Management Standards
• D) Claims Management Service
CMS is the federal agency that administers Medicare, Medicaid, and the
Children's Health Insurance Program (CHIP).
2. Which form is used to submit outpatient insurance claims?
• A) UB-04
• B) CMS-1500
• C) CMS-1450
• D) ADA Form
The CMS-1500 is the standard paper claim form for non-institutional
(outpatient) providers.
3. Which form is used for institutional (hospital) claims?
, • A) CMS-1500
• B) UB-04
• C) CMS-101
• D) HCFA-1500
The UB-04 (CMS-1450) is used by institutional providers such as hospitals.
4. What does EOB stand for?
• A) Explanation of Benefits
• B) Estimate of Billing
• C) Electronic Outpatient Billing
• D) Evaluation of Benefits
An EOB is a statement from the insurance company explaining what was paid,
denied, or applied to the patient's responsibility.
5. What does ERA stand for in medical billing?
• A) Electronic Remittance Advice
• B) Estimated Reimbursement Amount
• C) Electronic Review Authorization
• D) Explanation of Rejected Appeals
An ERA is the electronic version of an EOB sent to providers.
6. What is the purpose of an Advance Beneficiary Notice (ABN)?
• A) To authorize treatment
, • B) To inform the patient that Medicare may not pay for a service
• C) To verify insurance eligibility
• D) To appeal a denied claim
An ABN informs Medicare beneficiaries that a service may not be covered so
the patient can decide whether to proceed and accept financial responsibility.
7. What does CPT stand for?
• A) Certified Procedure Terminology
• B) Current Procedural Terminology
• C) Clinical Practice Transactions
• D) Coding Procedure Table
CPT codes describe medical, surgical, and diagnostic services and are
maintained by the AMA.
8. How many characters are in an ICD-10-CM diagnosis code (maximum)?
• A) 5
• B) 6
• C) 7
• D) 8
ICD-10-CM codes can be up to 7 characters long.
9. What does NPI stand for?
• A) National Provider Identifier
, • B) National Physician Index
• C) Network Provider Information
• D) Non-Participating Insurance
An NPI is a unique 10-digit identification number for healthcare providers.
10. Which modifier indicates a service was performed on both sides of the
body?
• A) -50
• B) -51
• C) -59
• D) -26
Modifier -50 indicates a bilateral procedure.
11. What is the purpose of modifier -25?
• A) Bilateral procedure
• B) Significant, separately identifiable E/M service on the same day as a
procedure
• C) Multiple procedures
• D) Distinct procedural service
Modifier -25 is used when a significant, separately identifiable E/M service is
performed on the same day as a procedure.
12. What does the term "clean claim" mean?
• A) A claim with no errors and complete information
Professional Biller Exam Prep Practice
Questions Answer Explanations • Medical
Billing • Claims • Reimbursement •
Insurance • Compliance Review
1. What does CMS stand for?
• A) Certified Medical System
• B) Centers for Medicare & Medicaid Services
• C) Clinical Management Standards
• D) Claims Management Service
CMS is the federal agency that administers Medicare, Medicaid, and the
Children's Health Insurance Program (CHIP).
2. Which form is used to submit outpatient insurance claims?
• A) UB-04
• B) CMS-1500
• C) CMS-1450
• D) ADA Form
The CMS-1500 is the standard paper claim form for non-institutional
(outpatient) providers.
3. Which form is used for institutional (hospital) claims?
, • A) CMS-1500
• B) UB-04
• C) CMS-101
• D) HCFA-1500
The UB-04 (CMS-1450) is used by institutional providers such as hospitals.
4. What does EOB stand for?
• A) Explanation of Benefits
• B) Estimate of Billing
• C) Electronic Outpatient Billing
• D) Evaluation of Benefits
An EOB is a statement from the insurance company explaining what was paid,
denied, or applied to the patient's responsibility.
5. What does ERA stand for in medical billing?
• A) Electronic Remittance Advice
• B) Estimated Reimbursement Amount
• C) Electronic Review Authorization
• D) Explanation of Rejected Appeals
An ERA is the electronic version of an EOB sent to providers.
6. What is the purpose of an Advance Beneficiary Notice (ABN)?
• A) To authorize treatment
, • B) To inform the patient that Medicare may not pay for a service
• C) To verify insurance eligibility
• D) To appeal a denied claim
An ABN informs Medicare beneficiaries that a service may not be covered so
the patient can decide whether to proceed and accept financial responsibility.
7. What does CPT stand for?
• A) Certified Procedure Terminology
• B) Current Procedural Terminology
• C) Clinical Practice Transactions
• D) Coding Procedure Table
CPT codes describe medical, surgical, and diagnostic services and are
maintained by the AMA.
8. How many characters are in an ICD-10-CM diagnosis code (maximum)?
• A) 5
• B) 6
• C) 7
• D) 8
ICD-10-CM codes can be up to 7 characters long.
9. What does NPI stand for?
• A) National Provider Identifier
, • B) National Physician Index
• C) Network Provider Information
• D) Non-Participating Insurance
An NPI is a unique 10-digit identification number for healthcare providers.
10. Which modifier indicates a service was performed on both sides of the
body?
• A) -50
• B) -51
• C) -59
• D) -26
Modifier -50 indicates a bilateral procedure.
11. What is the purpose of modifier -25?
• A) Bilateral procedure
• B) Significant, separately identifiable E/M service on the same day as a
procedure
• C) Multiple procedures
• D) Distinct procedural service
Modifier -25 is used when a significant, separately identifiable E/M service is
performed on the same day as a procedure.
12. What does the term "clean claim" mean?
• A) A claim with no errors and complete information
