AAPC- CPB (Certified Professional Biller)
2026|2027 practice Questions and
Answers|Accurate|Verified
1. Which type of health plan generally requires members to select a primary care
provider who coordinates most of their care?
A. PPO
B. HMO
C. Indemnity plan
D. Workers' compensation
Answer: B. HMO
2. What is the primary purpose of a Medicare Part B claim?
A. To bill inpatient room charges
B. To report outpatient medical services and physician services
C. To bill prescription medications exclusively
D. To report workers' compensation injuries
Answer: B. To report outpatient medical services and physician services
3. Which payer is primarily responsible for medical expenses resulting from an
employee's job-related injury?
A. Medicaid
B. Medicare
C. Workers' compensation
D. Medigap
Answer: C. Workers' compensation
4. What is a Medigap policy designed to do?
A. Replace Medicare entirely
B. Supplement certain Medicare cost-sharing responsibilities
C. Provide workers' compensation coverage
D. Cover automobile liability claims
Answer: B. Supplement certain Medicare cost-sharing responsibilities
5. A patient has two active health insurance policies. Which process determines the
order in which the plans pay?
A. Prior authorization
,B. Coordination of benefits
C. Medical necessity review
D. Credentialing
Answer: B. Coordination of benefits
6. Which organization administers the TRICARE program?
A. Department of Defense
B. Department of Labor
C. Social Security Administration
D. Department of Commerce
Answer: A. Department of Defense
7. Which payer commonly provides coverage to eligible low-income individuals
through federal and state programs?
A. Medicaid
B. Medigap
C. Workers' compensation
D. Commercial liability insurance
Answer: A. Medicaid
8. What is a PPO primarily known for?
A. Requiring every patient to obtain referrals for all specialists
B. Providing a network of preferred providers while generally allowing out-of-
network care at a higher cost
C. Covering only Medicare beneficiaries
D. Covering only workplace injuries
Answer: B. Providing a network of preferred providers while generally allowing out-
of-network care at a higher cost
9. Which payer generally covers medical services for individuals aged 65 and older
who meet eligibility requirements?
A. Medicaid only
B. Medicare
C. Workers' compensation
D. Automobile insurance
Answer: B. Medicare
10. What is the main purpose of verifying insurance eligibility before an
appointment?
A. To determine the patient's diagnosis
B. To confirm active coverage and benefit information
C. To assign an ICD-10-CM code
D. To determine the provider's specialty
, Answer: B. To confirm active coverage and benefit information
11. What does NCCI stand for?
A. National Claims Coverage Index
B. National Correct Coding Initiative
C. National Clinical Coding Institute
D. National Coverage Claims Initiative
Answer: B. National Correct Coding Initiative
12. What is the purpose of an NCCI edit?
A. To determine patient eligibility
B. To identify code combinations that generally should not be reported together
C. To calculate employee wages
D. To establish a patient's deductible
Answer: B. To identify code combinations that generally should not be reported
together
13. What does LCD stand for?
A. Local Coverage Determination
B. Limited Coding Directive
C. Local Claims Document
D. Liability Coverage Determination
Answer: A. Local Coverage Determination
14. What does NCD stand for?
A. National Claims Directive
B. National Coverage Determination
C. National Coding Database
D. National Compliance Document
Answer: B. National Coverage Determination
15. Which form is commonly used for professional medical claims?
A. UB-04
B. CMS-1500
C. W-2
D. I-9
Answer: B. CMS-1500
16. Which form is commonly used by institutional providers to submit facility
claims?
A. CMS-1500
B. UB-04
2026|2027 practice Questions and
Answers|Accurate|Verified
1. Which type of health plan generally requires members to select a primary care
provider who coordinates most of their care?
A. PPO
B. HMO
C. Indemnity plan
D. Workers' compensation
Answer: B. HMO
2. What is the primary purpose of a Medicare Part B claim?
A. To bill inpatient room charges
B. To report outpatient medical services and physician services
C. To bill prescription medications exclusively
D. To report workers' compensation injuries
Answer: B. To report outpatient medical services and physician services
3. Which payer is primarily responsible for medical expenses resulting from an
employee's job-related injury?
A. Medicaid
B. Medicare
C. Workers' compensation
D. Medigap
Answer: C. Workers' compensation
4. What is a Medigap policy designed to do?
A. Replace Medicare entirely
B. Supplement certain Medicare cost-sharing responsibilities
C. Provide workers' compensation coverage
D. Cover automobile liability claims
Answer: B. Supplement certain Medicare cost-sharing responsibilities
5. A patient has two active health insurance policies. Which process determines the
order in which the plans pay?
A. Prior authorization
,B. Coordination of benefits
C. Medical necessity review
D. Credentialing
Answer: B. Coordination of benefits
6. Which organization administers the TRICARE program?
A. Department of Defense
B. Department of Labor
C. Social Security Administration
D. Department of Commerce
Answer: A. Department of Defense
7. Which payer commonly provides coverage to eligible low-income individuals
through federal and state programs?
A. Medicaid
B. Medigap
C. Workers' compensation
D. Commercial liability insurance
Answer: A. Medicaid
8. What is a PPO primarily known for?
A. Requiring every patient to obtain referrals for all specialists
B. Providing a network of preferred providers while generally allowing out-of-
network care at a higher cost
C. Covering only Medicare beneficiaries
D. Covering only workplace injuries
Answer: B. Providing a network of preferred providers while generally allowing out-
of-network care at a higher cost
9. Which payer generally covers medical services for individuals aged 65 and older
who meet eligibility requirements?
A. Medicaid only
B. Medicare
C. Workers' compensation
D. Automobile insurance
Answer: B. Medicare
10. What is the main purpose of verifying insurance eligibility before an
appointment?
A. To determine the patient's diagnosis
B. To confirm active coverage and benefit information
C. To assign an ICD-10-CM code
D. To determine the provider's specialty
, Answer: B. To confirm active coverage and benefit information
11. What does NCCI stand for?
A. National Claims Coverage Index
B. National Correct Coding Initiative
C. National Clinical Coding Institute
D. National Coverage Claims Initiative
Answer: B. National Correct Coding Initiative
12. What is the purpose of an NCCI edit?
A. To determine patient eligibility
B. To identify code combinations that generally should not be reported together
C. To calculate employee wages
D. To establish a patient's deductible
Answer: B. To identify code combinations that generally should not be reported
together
13. What does LCD stand for?
A. Local Coverage Determination
B. Limited Coding Directive
C. Local Claims Document
D. Liability Coverage Determination
Answer: A. Local Coverage Determination
14. What does NCD stand for?
A. National Claims Directive
B. National Coverage Determination
C. National Coding Database
D. National Compliance Document
Answer: B. National Coverage Determination
15. Which form is commonly used for professional medical claims?
A. UB-04
B. CMS-1500
C. W-2
D. I-9
Answer: B. CMS-1500
16. Which form is commonly used by institutional providers to submit facility
claims?
A. CMS-1500
B. UB-04
