CPB Certified Professional Biller
Certification Exam Study Guide 2026/2027
| Complete Certification Preparation
Package | Practice Tests + Answer Key +
Rationales
Abuse - correct answer-Actions inconsistent with accepted, sound medical
business or fiscal practice
Accept Assignment - correct answer-Provider accepts as payment in full whatever
is paid on the cliam by the payer (except for any copayment and or coinsurance
amounts.)
Accounts Receivable - correct answer-The amount owed to a business for services
or goods provided.
Accounts Receivable Aging Report - correct answer-Shows the status (by date) of
outstanding claims from each payer, as well as payments due from patients.
Accounts Receivable Management - correct answer-Assists Providers in the
collection of appropriate reimbursement for services rendered; include functions
such as insurance verification/eligibility and preauthorization of services.
,Accreditation - correct answer-Voluntary Process that a healthcare facility or
organization (e.g. hospital or manged care plan) undergoes to demonstarte that it
has met standards beyond those required by law.
Adjudication - correct answer-Judicial dispuite resolution process in which an
appeals board makes a final determination.
Adjusted Claim - correct answer-payment correction resulting in additional
payment(s) to the provider.
Advance Beneficiary Notice (ABN) - correct answer-Document that acknowledges
patient responsiblity for payment if Medicare denies the cliam.
Adverse Effect - correct answer-Also called adverse reaction; the appearance of a
pathologic condition due to ingestion r exposure to a chemical substance properly
administered or taken.
Adverse Reaction - correct answer-Also called adverse effect; the appearance of a
pathologic condition due to ingestion r exposure to a chemical substance properly
administered or taken.
Adverse Selection - correct answer-Covering members who are sicker then the
general population.
Allowable Charge - correct answer-see limiting charge; maximum fee a physician
may charge.
, Allowed Charge - correct answer-The Maximum amount the payer will reimburse
for each procedure or service, according to the patients policy.
All Patient Diagnosis-Related Group (AP-DRG) - correct answer-DRG system
adapted for use by third-party payers to reimburse hospitals for inpatient care
provided to non-Medicare beneficiaries (e.g. Blue Cross Blue Shield, commercial
health plans, TRICARE); DRG assignment is based on intensity of resources.
All Patient Refined Diagnosis-Related Group (ARP-DRG) - correct answer-Adopted
by Medicare in 2008 to reimburse hospitals for inpatient care provided to
Medicare beneficiaries; expanded originial DRG system (based on intensity of
resources) to add two subclasses to each DRG that adjusts Medicare inpatient
hospital reimbursement rates for severity of illness (SOI) (extent of physiological
decompensation or organ system loss of function) and risk of mortality (ROM)
(likelihood of dying); each subclass, in turn, is subdivided into four areas: (1)
minor, (2) moderate, (3) major, (4) extreme.
Ambulance Fee Schedule - correct answer-Payment system for ambulance
services provided to Medicare Beneficiaries.
Ambulatory Payment Classification (APC) - correct answer-Prospective payment
system used to calculate reimbursement for outpatient care according to similar
clinical characteristics and in terms of resources required.
Ambulatory Surgical Center (ASC) - correct answer-State Licensed Medicare-
certified supplier (not provider) of surgical healthcare services that must accept
assignment on Medicare Claims.
Certification Exam Study Guide 2026/2027
| Complete Certification Preparation
Package | Practice Tests + Answer Key +
Rationales
Abuse - correct answer-Actions inconsistent with accepted, sound medical
business or fiscal practice
Accept Assignment - correct answer-Provider accepts as payment in full whatever
is paid on the cliam by the payer (except for any copayment and or coinsurance
amounts.)
Accounts Receivable - correct answer-The amount owed to a business for services
or goods provided.
Accounts Receivable Aging Report - correct answer-Shows the status (by date) of
outstanding claims from each payer, as well as payments due from patients.
Accounts Receivable Management - correct answer-Assists Providers in the
collection of appropriate reimbursement for services rendered; include functions
such as insurance verification/eligibility and preauthorization of services.
,Accreditation - correct answer-Voluntary Process that a healthcare facility or
organization (e.g. hospital or manged care plan) undergoes to demonstarte that it
has met standards beyond those required by law.
Adjudication - correct answer-Judicial dispuite resolution process in which an
appeals board makes a final determination.
Adjusted Claim - correct answer-payment correction resulting in additional
payment(s) to the provider.
Advance Beneficiary Notice (ABN) - correct answer-Document that acknowledges
patient responsiblity for payment if Medicare denies the cliam.
Adverse Effect - correct answer-Also called adverse reaction; the appearance of a
pathologic condition due to ingestion r exposure to a chemical substance properly
administered or taken.
Adverse Reaction - correct answer-Also called adverse effect; the appearance of a
pathologic condition due to ingestion r exposure to a chemical substance properly
administered or taken.
Adverse Selection - correct answer-Covering members who are sicker then the
general population.
Allowable Charge - correct answer-see limiting charge; maximum fee a physician
may charge.
, Allowed Charge - correct answer-The Maximum amount the payer will reimburse
for each procedure or service, according to the patients policy.
All Patient Diagnosis-Related Group (AP-DRG) - correct answer-DRG system
adapted for use by third-party payers to reimburse hospitals for inpatient care
provided to non-Medicare beneficiaries (e.g. Blue Cross Blue Shield, commercial
health plans, TRICARE); DRG assignment is based on intensity of resources.
All Patient Refined Diagnosis-Related Group (ARP-DRG) - correct answer-Adopted
by Medicare in 2008 to reimburse hospitals for inpatient care provided to
Medicare beneficiaries; expanded originial DRG system (based on intensity of
resources) to add two subclasses to each DRG that adjusts Medicare inpatient
hospital reimbursement rates for severity of illness (SOI) (extent of physiological
decompensation or organ system loss of function) and risk of mortality (ROM)
(likelihood of dying); each subclass, in turn, is subdivided into four areas: (1)
minor, (2) moderate, (3) major, (4) extreme.
Ambulance Fee Schedule - correct answer-Payment system for ambulance
services provided to Medicare Beneficiaries.
Ambulatory Payment Classification (APC) - correct answer-Prospective payment
system used to calculate reimbursement for outpatient care according to similar
clinical characteristics and in terms of resources required.
Ambulatory Surgical Center (ASC) - correct answer-State Licensed Medicare-
certified supplier (not provider) of surgical healthcare services that must accept
assignment on Medicare Claims.
