CPB Exam Study Guide
What is the drawback of an HMO? A. Providers have an incentive to keep treatment cost at a minimum.
B. The HMO administrators determine what services are reimbursed and what is
not.
C. The provider is now a gatekeeper to the patient's medical care.
D. All of the answers are correct
Answer: D All of the answer are correct
The healthcare carrier refused to accept MOD-RT and A. This is an example of a carrier-specific rule for a bilateral procedure (performed
MOD-LT and only accepted MOD-50. What does this on both sides of the body, right and left.
mean? B. This is considered an error on the carrier's part
C. This would never happen
D. Without additional information this means nothing
Answer: A- This is an example of a carrier-specific rule for a bilateral procedure
(performed on both sides of the body, right and left. In other words a carrier can
require MOD-50 over MOD-RT and LT even though technically they are the same.
What is not in the Medicare PFSRVU database? A. Global Days
B. Bilateral surgery modifier
C. RVU's
D. Medical Necessity
Answer: D- Medical Necessity
What are the characteristics of the emergency room visit? A. It applies equally to new and established patients
B. The Emergency Department must be available 24 hours a day
C. Both answers are correct
D. None of the answers are correct
Answer: C- Both answers are correct
These codes are used only for the emergency room encounters.
Which would be most likely not be covered under a A. Birth of child
corporate Family Medical Leave Act (FMLA)? B. Provide care for a sick spouse
C. An employees with a serious health condition
D. Vacations
Answer: D- Vacations
A PPO is a: A. Preferred Provider Organization, there is no gatekeeper
B. Provider Patient Organization, there is a gate keeper
C. Prospective Payment Option System where charges are diagnosis based
D. Provider Payment Option System where charges are diagnosis-based
Answer: A- Preferred Provider Organization, there is no gatekeeper like an HMO
To report co-management, which below must be true? A. Co-management only applies to doctors in the same clinic
B. Two physicians must be performing the surgical procedure
C. Two doctors must be managing the Post-op Care
D. None of the answers are correct
Answers: D- non of the answers are correct. The doctors must be in separate
office/clinics. Co-management refers to another provider providing the post-
operative care for a surgical procedure ( e. g., cataract surgery). Co-management is
not for two surgeons. Co-management refers to office visits and standard aftercare.
Two doctors cannot be paid for the same dates for Post-OP Care (different dates,
yes).
How does the CPT Professional Edition define a new A. A new patient is one who has not received any professional services from the
patient? physician or another physician of the same specialty who belongs to the same
group practice, within the past two years.
B. A new patient is one who has not received any professional services from the
physician or another physician of the same specialty who belongs to the same
group practice, within the past three years.
C. A new patient is one who has received professional services from the physician
or another physician of the same specialty within the last two years for the same
problem
D. A new patient is one who has received hospital services but has never been
seen in the clinic by the reporting physician.
Answer: B. A new patient is one who have not received any professional services
from the physician or another physician of the same specialty who belongs to the
same group practice, within the past three years.
Stuvia 2026-2027
, CPB Exam Study Guide
If a doctor or supplier "accepts" (Medicare) assignment A. The client is only responsible for paying 20 percent of the amount set by
then: Medicare, even if that amount is less than what the doctor or provider normally
charges.
B. The client is responsible for paying 100% percent of the amount set by Medicare.
C. The client is only responsible for paying 20 percent of the amount set by
Medicare, or what the doctor or provider normally charges, whichever is less.
D. The doctor or provider is limited to charging the client an additional 15 percent of
the Medicare amount, This is called a limiting charge.
Answer: A- The Client is only responsible for paying 20 percent of the amount set by
Medicare, even if that amount is less than what the doctor or provider normally
charges.
Medicare Part-A is: A. Billed on the UB-04 Form
B. Submitted for Facility Fees
C. A mandatory program
D. All of the answers are correct
Answer: D- All the answers are correct
At 65 everyone must enroll in Medicare Part-A. Part-B is voluntary. The professional
fees for the surgeon are submitted on the CMS-1500 form.
Which statement could be found in a medical carrier A. That all their contracted patients must receive their most favorable pricing ( No
contract? other carrier can be lower, especially Medicare)
B. That is the claim is not filed within the "Timely Filing Period" then they cannot bill
the patient (if the carrier refuses payment).
C. For children they must provide specific services such as immunizations, hearing
or vision tests, or other required services.
D. All of the answers are correct.
Answer: D All of the answers are correct
Contracts can have a very unique and specific payment and compliance
requirements.
What is the official medicare appeals process? A. Medicare has five levels of appeals
B. Medicare has seven levels of appeals
C. Medicare has levels of appeals
D. There is no official Medicare appeals process.
Answer: A- Medicare has five levels of appeals
First level- Redetermination by a Medicare carrier, fiscal intermediary (FI), or
Medicare administrative Contractor (MAC).
Second level- Reconsideration by a Qualified Independent Contractor(QIC)
Third level- Hearing by an Administrative Law Judge (ALJ) in the office of Medicare
Hearing and Appeals.
Fourth level- Review by the Medicare Appeals Council
Fifth level- Judicial Review in Federal District Court.
A living will, personal directive, advance directive, or A. An Advance Health Care Directive
advance decision are all examples of what? B. Power of Attorney
C. HIPAA Guidelines
D. Stark Law
Answer: A- An Advance Health Care Directive
Appoints a person to make such decisions on their behalf.
The global period is: A. Zero, 10, 90
B. Zero, 10, 30, or 90
C. It is a carrier-specific rule and can be any number
D. This determines whether a patient is new or established
Answer: A- Zero, 10, or 90
These are established by Medicare and are zero, 10, or 90. The information is not in
the CPT manual and found in the PFSRVU database.
What is a Certificate of Authority used for? A. Issued by the state, it licenses the operation of an HMO
B. Issued by CMS, it licenses the operation of an HMO
C. Issued by the state, it licenses the operation of an PPO
D. Issued by CMS, it licenses the operation of Medicaid
Answer: A- Issued by the state, it licenses the operation of an HMO. Certificate of
Authority (COA) is issued by the state. It licenses the operation of an HMO (health
Maintenance Organization).
Stuvia 2026-2027
, CPB Exam Study Guide
What does COBRA mean? A. Co-Insurance Overhead Reimbursement Act.
B. Consolidated Oversight Bill for Insurance
C. Consolidated Omnibus Budget Reconciliation Act
D. Cooperative Office for Budgetary Reconciliation Act
Answer: C. Consolidated Omnibus Budget Reconciliation Act
TRICARE is A. The single payer insurance carrier for armed forces a personnel
B. Is one of the Medicare Part-B carriers
C. is a secondary insurance to Medicare (Medigap)
D. Is a division of Blue Cross Blue Shield
Answer: A- The single payer insurance carrier for armed forces a personnel.
TRICARE, formerly known as the Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS), is a single-payer health care program of the
United States Department of Defense Military Health System.
APC's are used for what Places of Service (POS) ? A. Hospital outpatient services, Free-standing Ambulatory Service Centers (ACO's)
B. Hospital Inpatient Only
C. Skilled Nursing Facilities
D. Nursing Homes, Home Health Care
Answer: A- Hospital outpatient services, Free-standing Ambulatory Service Centers
(ACO's)
The patients are not admitted to the hospital. They are outpatients receiving
outpatient surgery or services. In addition to the fee for professional services (billed
separately on the CMS-1500 form), a facility fee is billed on the UB-04 from using
APC's.
Which statement(s) describe a passive natural acquired A. Use of immunoglobulin harvested from a donor who developed resistance
immunity process? against specific antigens
B. The passage of antibodies through the placenta or breast milk.
C. Immunization that uses a greatly weakened form of antigen, thus enabling the
body to develop antibodies in response to this intentional exposure.
D. Both A and C
Answer: B- The passage of antibodies through the placenta or breast milk.
Both the use of vaccination and immunoglobulins harvested are "artificial" not
"natural" means of immunity.
Medicare Part-A billing is for reporting A. Surgery coding only
B. All procedures performed in the hospital
C. All procedures not performed in the hospital. (Professional Component)
D. Facility services for inpatient services.
Answer: All procedures performed in the hospital
Facility services for inpatient services.
Which components below are part of Medicare Part-B? A. CMS-1500 form
B. CPT Codes
C. ICD-10 Codes
D. All of the answers are correct
Answer: D- All of the answers are correct
Covered Workers Compensation entities may disclose A. Workers Compensation insurers and others involved in workers' compensation
protected health information to who? systems
B. Attorneys in civil prosecution cases.
C. Workers Comp information cannot be shared.
D. Immediate family members only.
Answer: A- Workers Compensation insurers and others involved in workers'
compensation systems.
With OSHA and the Mine Safety and Health Administration (MSHA) for example.
What are the average percentages for the work, practice A. the percentages are, respectively: 30.1, 29.9 and 30
expense, and malpractice insurance RVU's? B. The percentage are, respectively: 43.6, 52.5 and 3.9
C. The percentages are, respectively: 82.5, 20.6 and 16.9
D. The percentages are, respectively: 52.5, 43.6 and 3.9
Answer: D- The percentage are, respectively: 52.5, 43.6 and 3.9
The split of RVUs varies by physician service but as a general guideline (on
average) are, respectively: 52.5, 43.6 and 3.9
Stuvia 2026-2027
What is the drawback of an HMO? A. Providers have an incentive to keep treatment cost at a minimum.
B. The HMO administrators determine what services are reimbursed and what is
not.
C. The provider is now a gatekeeper to the patient's medical care.
D. All of the answers are correct
Answer: D All of the answer are correct
The healthcare carrier refused to accept MOD-RT and A. This is an example of a carrier-specific rule for a bilateral procedure (performed
MOD-LT and only accepted MOD-50. What does this on both sides of the body, right and left.
mean? B. This is considered an error on the carrier's part
C. This would never happen
D. Without additional information this means nothing
Answer: A- This is an example of a carrier-specific rule for a bilateral procedure
(performed on both sides of the body, right and left. In other words a carrier can
require MOD-50 over MOD-RT and LT even though technically they are the same.
What is not in the Medicare PFSRVU database? A. Global Days
B. Bilateral surgery modifier
C. RVU's
D. Medical Necessity
Answer: D- Medical Necessity
What are the characteristics of the emergency room visit? A. It applies equally to new and established patients
B. The Emergency Department must be available 24 hours a day
C. Both answers are correct
D. None of the answers are correct
Answer: C- Both answers are correct
These codes are used only for the emergency room encounters.
Which would be most likely not be covered under a A. Birth of child
corporate Family Medical Leave Act (FMLA)? B. Provide care for a sick spouse
C. An employees with a serious health condition
D. Vacations
Answer: D- Vacations
A PPO is a: A. Preferred Provider Organization, there is no gatekeeper
B. Provider Patient Organization, there is a gate keeper
C. Prospective Payment Option System where charges are diagnosis based
D. Provider Payment Option System where charges are diagnosis-based
Answer: A- Preferred Provider Organization, there is no gatekeeper like an HMO
To report co-management, which below must be true? A. Co-management only applies to doctors in the same clinic
B. Two physicians must be performing the surgical procedure
C. Two doctors must be managing the Post-op Care
D. None of the answers are correct
Answers: D- non of the answers are correct. The doctors must be in separate
office/clinics. Co-management refers to another provider providing the post-
operative care for a surgical procedure ( e. g., cataract surgery). Co-management is
not for two surgeons. Co-management refers to office visits and standard aftercare.
Two doctors cannot be paid for the same dates for Post-OP Care (different dates,
yes).
How does the CPT Professional Edition define a new A. A new patient is one who has not received any professional services from the
patient? physician or another physician of the same specialty who belongs to the same
group practice, within the past two years.
B. A new patient is one who has not received any professional services from the
physician or another physician of the same specialty who belongs to the same
group practice, within the past three years.
C. A new patient is one who has received professional services from the physician
or another physician of the same specialty within the last two years for the same
problem
D. A new patient is one who has received hospital services but has never been
seen in the clinic by the reporting physician.
Answer: B. A new patient is one who have not received any professional services
from the physician or another physician of the same specialty who belongs to the
same group practice, within the past three years.
Stuvia 2026-2027
, CPB Exam Study Guide
If a doctor or supplier "accepts" (Medicare) assignment A. The client is only responsible for paying 20 percent of the amount set by
then: Medicare, even if that amount is less than what the doctor or provider normally
charges.
B. The client is responsible for paying 100% percent of the amount set by Medicare.
C. The client is only responsible for paying 20 percent of the amount set by
Medicare, or what the doctor or provider normally charges, whichever is less.
D. The doctor or provider is limited to charging the client an additional 15 percent of
the Medicare amount, This is called a limiting charge.
Answer: A- The Client is only responsible for paying 20 percent of the amount set by
Medicare, even if that amount is less than what the doctor or provider normally
charges.
Medicare Part-A is: A. Billed on the UB-04 Form
B. Submitted for Facility Fees
C. A mandatory program
D. All of the answers are correct
Answer: D- All the answers are correct
At 65 everyone must enroll in Medicare Part-A. Part-B is voluntary. The professional
fees for the surgeon are submitted on the CMS-1500 form.
Which statement could be found in a medical carrier A. That all their contracted patients must receive their most favorable pricing ( No
contract? other carrier can be lower, especially Medicare)
B. That is the claim is not filed within the "Timely Filing Period" then they cannot bill
the patient (if the carrier refuses payment).
C. For children they must provide specific services such as immunizations, hearing
or vision tests, or other required services.
D. All of the answers are correct.
Answer: D All of the answers are correct
Contracts can have a very unique and specific payment and compliance
requirements.
What is the official medicare appeals process? A. Medicare has five levels of appeals
B. Medicare has seven levels of appeals
C. Medicare has levels of appeals
D. There is no official Medicare appeals process.
Answer: A- Medicare has five levels of appeals
First level- Redetermination by a Medicare carrier, fiscal intermediary (FI), or
Medicare administrative Contractor (MAC).
Second level- Reconsideration by a Qualified Independent Contractor(QIC)
Third level- Hearing by an Administrative Law Judge (ALJ) in the office of Medicare
Hearing and Appeals.
Fourth level- Review by the Medicare Appeals Council
Fifth level- Judicial Review in Federal District Court.
A living will, personal directive, advance directive, or A. An Advance Health Care Directive
advance decision are all examples of what? B. Power of Attorney
C. HIPAA Guidelines
D. Stark Law
Answer: A- An Advance Health Care Directive
Appoints a person to make such decisions on their behalf.
The global period is: A. Zero, 10, 90
B. Zero, 10, 30, or 90
C. It is a carrier-specific rule and can be any number
D. This determines whether a patient is new or established
Answer: A- Zero, 10, or 90
These are established by Medicare and are zero, 10, or 90. The information is not in
the CPT manual and found in the PFSRVU database.
What is a Certificate of Authority used for? A. Issued by the state, it licenses the operation of an HMO
B. Issued by CMS, it licenses the operation of an HMO
C. Issued by the state, it licenses the operation of an PPO
D. Issued by CMS, it licenses the operation of Medicaid
Answer: A- Issued by the state, it licenses the operation of an HMO. Certificate of
Authority (COA) is issued by the state. It licenses the operation of an HMO (health
Maintenance Organization).
Stuvia 2026-2027
, CPB Exam Study Guide
What does COBRA mean? A. Co-Insurance Overhead Reimbursement Act.
B. Consolidated Oversight Bill for Insurance
C. Consolidated Omnibus Budget Reconciliation Act
D. Cooperative Office for Budgetary Reconciliation Act
Answer: C. Consolidated Omnibus Budget Reconciliation Act
TRICARE is A. The single payer insurance carrier for armed forces a personnel
B. Is one of the Medicare Part-B carriers
C. is a secondary insurance to Medicare (Medigap)
D. Is a division of Blue Cross Blue Shield
Answer: A- The single payer insurance carrier for armed forces a personnel.
TRICARE, formerly known as the Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS), is a single-payer health care program of the
United States Department of Defense Military Health System.
APC's are used for what Places of Service (POS) ? A. Hospital outpatient services, Free-standing Ambulatory Service Centers (ACO's)
B. Hospital Inpatient Only
C. Skilled Nursing Facilities
D. Nursing Homes, Home Health Care
Answer: A- Hospital outpatient services, Free-standing Ambulatory Service Centers
(ACO's)
The patients are not admitted to the hospital. They are outpatients receiving
outpatient surgery or services. In addition to the fee for professional services (billed
separately on the CMS-1500 form), a facility fee is billed on the UB-04 from using
APC's.
Which statement(s) describe a passive natural acquired A. Use of immunoglobulin harvested from a donor who developed resistance
immunity process? against specific antigens
B. The passage of antibodies through the placenta or breast milk.
C. Immunization that uses a greatly weakened form of antigen, thus enabling the
body to develop antibodies in response to this intentional exposure.
D. Both A and C
Answer: B- The passage of antibodies through the placenta or breast milk.
Both the use of vaccination and immunoglobulins harvested are "artificial" not
"natural" means of immunity.
Medicare Part-A billing is for reporting A. Surgery coding only
B. All procedures performed in the hospital
C. All procedures not performed in the hospital. (Professional Component)
D. Facility services for inpatient services.
Answer: All procedures performed in the hospital
Facility services for inpatient services.
Which components below are part of Medicare Part-B? A. CMS-1500 form
B. CPT Codes
C. ICD-10 Codes
D. All of the answers are correct
Answer: D- All of the answers are correct
Covered Workers Compensation entities may disclose A. Workers Compensation insurers and others involved in workers' compensation
protected health information to who? systems
B. Attorneys in civil prosecution cases.
C. Workers Comp information cannot be shared.
D. Immediate family members only.
Answer: A- Workers Compensation insurers and others involved in workers'
compensation systems.
With OSHA and the Mine Safety and Health Administration (MSHA) for example.
What are the average percentages for the work, practice A. the percentages are, respectively: 30.1, 29.9 and 30
expense, and malpractice insurance RVU's? B. The percentage are, respectively: 43.6, 52.5 and 3.9
C. The percentages are, respectively: 82.5, 20.6 and 16.9
D. The percentages are, respectively: 52.5, 43.6 and 3.9
Answer: D- The percentage are, respectively: 52.5, 43.6 and 3.9
The split of RVUs varies by physician service but as a general guideline (on
average) are, respectively: 52.5, 43.6 and 3.9
Stuvia 2026-2027
