Master your AAPC Certified Professional Biller (CPB) exam on the very first try!
This extensive study resource features 459 highly relevant practice questions
paired with 100% verified solutions. Designed to simulate the rigor and tone of the
actual exam, this guide helps you identify your knowledge gaps and master the
billing concepts required for professional certification.
What’s Included:
• 459 Realistic Practice Questions: Covers multiple-choice variations tracking
essential testing objectives.
• Verified Solutions & Keys: Instantly check your accuracy and understand
core principles.
• High-Yield Core Concept Coverage: Thoroughly tests your grasp on the
Birthday Rule, CMS-1500 claim entry, HIPAA compliance, Medicare
guidelines, and modifier usage (Modifiers 24, 25, 59).
Key Topics Covered:
• Revenue Cycle Management: Front-end demographics to back-end
strategies.
• Insurance Plans & Regulations:
Medicare, Medicaid, Commercial Payers, Workers’ Comp, and TRICARE.
• Claims Processing & Denials: Error identification, timely filing, and appeal
basics.
• Billing Compliance: Fraud and abuse regulations, NCCI unbundling, and
medical ethics.
Format: Digital Download. Perfect for final reviews, time-management practice, or
building confidence before test day.
Quiz__________?
Joe and Mary are a married couple and both carry insurance from their employers.
Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the
birthday rule, who carries the primary insurance for their children for billing?
A. Joe, because he is the male head of the household.
1
, B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd.
C. Mary, because her birth year is before Joe's birth year.
D. Joe, because his birth month and day are before Mary's birth month and day. -
Answer✅
D. Joe, because his birth month and day are before Mary's birth month and day.
Quiz__________?
Which type of managed care insurance allows patients to self-refer to out-of-network
providers and pay a higher co-insurance/copay amount?
I. HMO
II. PPO
III. EPO
IV. POS
V. Capitation
A. II
B. IV
C. II and IV
D. II, III, and V -
Answer✅
C. II and IV
Quiz__________?
A patient covered by a PPO is scheduled for knee replacement surgery. The biller
contacts the insurance carrier to verify benefits and preauthorize the procedure. The
carrier verifies the patient has a $500 deductible which must be met. After the
deductible, the PPO will pay 80% of the claim. The contracted rate for the procedure
is $2,500. What is the patient's responsibility?
A. $400
B. $500
C. $900
D. $1,600 -
Answer✅
C. $900
Quiz__________?
When a nonparticipating provider files a claim for a patient to BC/BS, how is the
payment processed?
A. The payment is sent to the patient and the patient must pay the provider.
B. The payment is sent to the provider if the provider agrees to accept assignment.
C. The payment is sent to the provider regardless if he accepts assignment.
D. The claim is not paid because the provider is not participating in the plan. -
Answer✅
A. The payment is sent to the patient and the patient must pay the provider.
Quiz__________?
2
, Which of the following TRICARE options is/are available to active duty service
members?
A. TRICARE Select
B. TRICARE Prime
C. TRICARE For Life
D. TRICARE Young Adult -
Answer✅
B. TRICARE Prime
Quiz__________?
A Medicare card will list which of the following:
I. Effective date of coverage
II. Home address
III. Telephone Number
IV. Entitled to Part A and/or Part B
V. When coverage ends
VI. Name of Primary Care Physician
A. I - VI
B. I, IV
C. I-III, VI
D. I, II, IV, V -
Answer✅
B. I, IV
Quiz__________?
In which of the following scenarios is Medicare the secondary payer?
I. A 65 year-old patient who is collecting her deceased spouse's Medicare benefits
and has a supplemental insurance
II. A 72 year-old patient who participates in the group health insurance of his
employer
III. A 66 year-old patient is injured at work and the employer does not offer health
insurance as a benefit of employment
IV. A 55 year-old patient who is on disability through Social Security and qualifies for
Medicaid and Medicare
A. I-IV
B. II and III
C. I and IV
D. None -
Answer✅
B. II and III
Quiz__________?
When a patient has Medicare primary and AARP as Medigap, what is entered on the
CMS-1500 claim form in item 9d for the Insurance Plan Name or Program Name for
Medicare to cross over the claim?
3
, A. Plan name followed by "MEDIGAP"
B. Plan Payer ID followed by "MEDIGAP"
C. COBA Medigap claim-based identifier (ID)
D. Leave blank -
Answer✅
C. COBA Medigap claim-based identifier (ID)
Quiz__________?
Which guidelines must all billing personnel be knowledgeable about in order to
ensure compliance with Medicaid programs?
A. Federal guidelines
B. State guidelines
C. Both A and B
D. None -
Answer✅
C. Both A and B
Quiz__________?
Which of the following services is covered by Early and Periodic Screening,
Diagnostic, and Treatment (EPSDT)?
A. Family planning
B. Obstetric care
C. Pediatric checkups
D. Emergency department visits -
Answer✅
C. Pediatric checkups
Quiz__________?
A female patient who was involved in an auto accident presents to the emergency
department (ED) for evaluation. She does not have any complaints. The provider
evaluates her and determines there are no injuries. The provider informs the patient
to come back to the ED or see her primary care physician if she develops any
symptoms. How is the claim processed for this encounter?
A. The medical insurance is billed primary and the auto insurance is billed
secondary.
B. The auto insurance is billed primary and the medical insurance is billed
secondary.
C. Bill the medical insurance first to receive a denial and then submit with the
remittance advice to the auto insurance.
D. Bill only the medical insurance because the auto insurance only covers damage
to the vehicle, not medical expenses. -
Answer✅
B. The auto insurance is billed primary and the medical insurance is billed
secondary.
4
This extensive study resource features 459 highly relevant practice questions
paired with 100% verified solutions. Designed to simulate the rigor and tone of the
actual exam, this guide helps you identify your knowledge gaps and master the
billing concepts required for professional certification.
What’s Included:
• 459 Realistic Practice Questions: Covers multiple-choice variations tracking
essential testing objectives.
• Verified Solutions & Keys: Instantly check your accuracy and understand
core principles.
• High-Yield Core Concept Coverage: Thoroughly tests your grasp on the
Birthday Rule, CMS-1500 claim entry, HIPAA compliance, Medicare
guidelines, and modifier usage (Modifiers 24, 25, 59).
Key Topics Covered:
• Revenue Cycle Management: Front-end demographics to back-end
strategies.
• Insurance Plans & Regulations:
Medicare, Medicaid, Commercial Payers, Workers’ Comp, and TRICARE.
• Claims Processing & Denials: Error identification, timely filing, and appeal
basics.
• Billing Compliance: Fraud and abuse regulations, NCCI unbundling, and
medical ethics.
Format: Digital Download. Perfect for final reviews, time-management practice, or
building confidence before test day.
Quiz__________?
Joe and Mary are a married couple and both carry insurance from their employers.
Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the
birthday rule, who carries the primary insurance for their children for billing?
A. Joe, because he is the male head of the household.
1
, B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd.
C. Mary, because her birth year is before Joe's birth year.
D. Joe, because his birth month and day are before Mary's birth month and day. -
Answer✅
D. Joe, because his birth month and day are before Mary's birth month and day.
Quiz__________?
Which type of managed care insurance allows patients to self-refer to out-of-network
providers and pay a higher co-insurance/copay amount?
I. HMO
II. PPO
III. EPO
IV. POS
V. Capitation
A. II
B. IV
C. II and IV
D. II, III, and V -
Answer✅
C. II and IV
Quiz__________?
A patient covered by a PPO is scheduled for knee replacement surgery. The biller
contacts the insurance carrier to verify benefits and preauthorize the procedure. The
carrier verifies the patient has a $500 deductible which must be met. After the
deductible, the PPO will pay 80% of the claim. The contracted rate for the procedure
is $2,500. What is the patient's responsibility?
A. $400
B. $500
C. $900
D. $1,600 -
Answer✅
C. $900
Quiz__________?
When a nonparticipating provider files a claim for a patient to BC/BS, how is the
payment processed?
A. The payment is sent to the patient and the patient must pay the provider.
B. The payment is sent to the provider if the provider agrees to accept assignment.
C. The payment is sent to the provider regardless if he accepts assignment.
D. The claim is not paid because the provider is not participating in the plan. -
Answer✅
A. The payment is sent to the patient and the patient must pay the provider.
Quiz__________?
2
, Which of the following TRICARE options is/are available to active duty service
members?
A. TRICARE Select
B. TRICARE Prime
C. TRICARE For Life
D. TRICARE Young Adult -
Answer✅
B. TRICARE Prime
Quiz__________?
A Medicare card will list which of the following:
I. Effective date of coverage
II. Home address
III. Telephone Number
IV. Entitled to Part A and/or Part B
V. When coverage ends
VI. Name of Primary Care Physician
A. I - VI
B. I, IV
C. I-III, VI
D. I, II, IV, V -
Answer✅
B. I, IV
Quiz__________?
In which of the following scenarios is Medicare the secondary payer?
I. A 65 year-old patient who is collecting her deceased spouse's Medicare benefits
and has a supplemental insurance
II. A 72 year-old patient who participates in the group health insurance of his
employer
III. A 66 year-old patient is injured at work and the employer does not offer health
insurance as a benefit of employment
IV. A 55 year-old patient who is on disability through Social Security and qualifies for
Medicaid and Medicare
A. I-IV
B. II and III
C. I and IV
D. None -
Answer✅
B. II and III
Quiz__________?
When a patient has Medicare primary and AARP as Medigap, what is entered on the
CMS-1500 claim form in item 9d for the Insurance Plan Name or Program Name for
Medicare to cross over the claim?
3
, A. Plan name followed by "MEDIGAP"
B. Plan Payer ID followed by "MEDIGAP"
C. COBA Medigap claim-based identifier (ID)
D. Leave blank -
Answer✅
C. COBA Medigap claim-based identifier (ID)
Quiz__________?
Which guidelines must all billing personnel be knowledgeable about in order to
ensure compliance with Medicaid programs?
A. Federal guidelines
B. State guidelines
C. Both A and B
D. None -
Answer✅
C. Both A and B
Quiz__________?
Which of the following services is covered by Early and Periodic Screening,
Diagnostic, and Treatment (EPSDT)?
A. Family planning
B. Obstetric care
C. Pediatric checkups
D. Emergency department visits -
Answer✅
C. Pediatric checkups
Quiz__________?
A female patient who was involved in an auto accident presents to the emergency
department (ED) for evaluation. She does not have any complaints. The provider
evaluates her and determines there are no injuries. The provider informs the patient
to come back to the ED or see her primary care physician if she develops any
symptoms. How is the claim processed for this encounter?
A. The medical insurance is billed primary and the auto insurance is billed
secondary.
B. The auto insurance is billed primary and the medical insurance is billed
secondary.
C. Bill the medical insurance first to receive a denial and then submit with the
remittance advice to the auto insurance.
D. Bill only the medical insurance because the auto insurance only covers damage
to the vehicle, not medical expenses. -
Answer✅
B. The auto insurance is billed primary and the medical insurance is billed
secondary.
4
