AAPC Certified Professional Biller (CPB) Final
Exam 2025–2026 Accurate Real Exam Questions
and Verified Correct Answers JUST RELEASED
What entities are exempt from HIPAA and not considered to be covered entities?
a. Workers' compensation
b. Employers with less than 100 employees
c .Church-sponsored plans
d. Sponsored group plans
a. Workers' compensation
Which of the following documentation is NOT needed for an audit?
a. Encounter form
b. Medical record
c. Explanation of Benefits
d. CMS-1500 claim form
c. Explanation of Benefits
We have an expert-written solution to this problem!
Which of the following determines the amount the hospital will be reimbursed for
inpatient services if the patient is covered by Medicare?
a. Healthcare Common Procedure Coding System (HCPCS)
,b. Resource-Based Relative Value Scale (RBRVS)
c. Medicare Severity-Diagnosis Related Groups (MS-DRGs)
d. Ambulatory Payment Classification (APC)
d. Ambulatory Payment Classification (APC)
Which is NOT used for data entry?
a. Maintaining an internal audit system
b. Demographic information
c .CPT® and ICD-10-CM codes to report the services for that encounter
d. Payments from insurance carriers
a. Maintaining an internal audit system
A claim has been denied as not medically necessary by Medicare. The biller has checked
the patient's medical record and the patient's insurance policy. No ABN was signed. What
is the next action the biller should take?
I. Write-off the charge
II. Check with the provider to appeal the claim
III. Transfer the charge to the patient's account
a. I
b. I or II
c. II or III
,d. III
c. II or III
Review the following financial policy:
Collections Policy: Invoices not paid within 60 days begin our collection process. Invoices
not paid within 120 days are subject to patient dismissal and submission to our Collection
Agency and notification to your insurance plan.
According to this policy, at what age is a balance owed by the patient considered a bad
debt and sent to their collection agency?
a. 120 days
b. 30 days
c. 365 days
d. 60 days
a. 120 days
We have an expert-written solution to this problem!
What does a high number of days in A/R indicate for a medical practice?
a. The days in A/R do not indicate anything about the practice.
b. The practice is using their A/R for loan purposes.
, c. The practice has good policies in place, which results in good collections of outstanding
balances.
d. The practice potentially has a problem in the revenue cycle.
d. The practice potentially has a problem in the revenue cycle.
A provider removes a skin lesion in an ASC and receives a denial from the insurance
carrier that states "Lower level of care could have been provided." What steps should the
biller take?
a. Check with the provider and write an appeal to the insurance carrier explaining why
the service was not an inpatient service.
b. Write-off the charge.
c. Check with the provider and write an appeal to the insurance carrier explaining why
the service was provided in the ASC.
d. Submit the CMS-1500 claim form with a different place of service code.
c. Check with the provider and write an appeal to the insurance carrier explaining why
the service was provided in the ASC.
What steps should be taken when a medical office receives notice that a patient has filed
bankruptcy?
a. Stop all collection efforts and dismiss the patient from the practice.
Exam 2025–2026 Accurate Real Exam Questions
and Verified Correct Answers JUST RELEASED
What entities are exempt from HIPAA and not considered to be covered entities?
a. Workers' compensation
b. Employers with less than 100 employees
c .Church-sponsored plans
d. Sponsored group plans
a. Workers' compensation
Which of the following documentation is NOT needed for an audit?
a. Encounter form
b. Medical record
c. Explanation of Benefits
d. CMS-1500 claim form
c. Explanation of Benefits
We have an expert-written solution to this problem!
Which of the following determines the amount the hospital will be reimbursed for
inpatient services if the patient is covered by Medicare?
a. Healthcare Common Procedure Coding System (HCPCS)
,b. Resource-Based Relative Value Scale (RBRVS)
c. Medicare Severity-Diagnosis Related Groups (MS-DRGs)
d. Ambulatory Payment Classification (APC)
d. Ambulatory Payment Classification (APC)
Which is NOT used for data entry?
a. Maintaining an internal audit system
b. Demographic information
c .CPT® and ICD-10-CM codes to report the services for that encounter
d. Payments from insurance carriers
a. Maintaining an internal audit system
A claim has been denied as not medically necessary by Medicare. The biller has checked
the patient's medical record and the patient's insurance policy. No ABN was signed. What
is the next action the biller should take?
I. Write-off the charge
II. Check with the provider to appeal the claim
III. Transfer the charge to the patient's account
a. I
b. I or II
c. II or III
,d. III
c. II or III
Review the following financial policy:
Collections Policy: Invoices not paid within 60 days begin our collection process. Invoices
not paid within 120 days are subject to patient dismissal and submission to our Collection
Agency and notification to your insurance plan.
According to this policy, at what age is a balance owed by the patient considered a bad
debt and sent to their collection agency?
a. 120 days
b. 30 days
c. 365 days
d. 60 days
a. 120 days
We have an expert-written solution to this problem!
What does a high number of days in A/R indicate for a medical practice?
a. The days in A/R do not indicate anything about the practice.
b. The practice is using their A/R for loan purposes.
, c. The practice has good policies in place, which results in good collections of outstanding
balances.
d. The practice potentially has a problem in the revenue cycle.
d. The practice potentially has a problem in the revenue cycle.
A provider removes a skin lesion in an ASC and receives a denial from the insurance
carrier that states "Lower level of care could have been provided." What steps should the
biller take?
a. Check with the provider and write an appeal to the insurance carrier explaining why
the service was not an inpatient service.
b. Write-off the charge.
c. Check with the provider and write an appeal to the insurance carrier explaining why
the service was provided in the ASC.
d. Submit the CMS-1500 claim form with a different place of service code.
c. Check with the provider and write an appeal to the insurance carrier explaining why
the service was provided in the ASC.
What steps should be taken when a medical office receives notice that a patient has filed
bankruptcy?
a. Stop all collection efforts and dismiss the patient from the practice.
