CPB CERTIFIED PROFESSIONAL
BILLER CERTIFICATION EXAM 2025/
2026 QUESTIONS WITH VERIFIED
ANSWERS
1. beneficiary counseling and assistance coordinator (BCAC) - correct answer -individual
available at military treatment facility (MTF) to answer questions, help solve healthcare
related problems, and assist beneficiaries in obtaining medical care through TRICARE;
was previously called health benefits advisor (HBA)
2. benefit period (Medicare) - correct answer -begins with the first day of hospitalization
and ends when the patient has been out of the hospital for 60 consecutive days.
3. benign - correct answer -not cancerous
4. billing entity - correct answer -the legal business name of the provider's pratice.
5. birthday rule - correct answer -determines coverage by primary and secondary policies
when each parent subscribes to a different health insurance plan.
,6. black box edits - correct answer -nonpublished code edits, which were discontinued in
2000.
7. BlueCard Program - correct answer -program that allows BCBS subscribers to receive
local Blue Plan healthcare benefits while traveling or living outside of their plan's area.
8. Blue Cross (BC) - correct answer -insurance plan created in 1929 when Baylor University
Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that
guaranteed up to 21 days of hospitalization per year for subscribers and each dependent
for a $6 annual premium.
9. Blue Cross Blue Shield (BCBS) - correct answer -joint venture between Blue Cross and
Blue Shield where the corporation shared one building and computer
10. The coding system currently in use to report diagnoses and reasons for encounter is the:
- correct answer -International Classification of Diseases, 9th revision, clinical
modification (ICD-9-CM)
11. The person who prepares and reviews claims for accuracy to ensure prompt payment is
the : - correct answer -Health Insurance Specialist
12. Medical Ethics are: - correct answer -Principles of right or good conduct
,13. A person who performs services for another under an expressed or implied agreement is
called a(n): - correct answer -Independent Contractor
14. Which is an authorization that must be received from a payer before treatment by a
specialist wil be covered? - correct answer -Preauthorization
15. Which coding systerm is used to report professional services to payers? - correct answer
-Current Procedural Terminology (CPT)
16. Which is a crucial skill that all health insurance specialists should learn in their training
coursework? - correct answer -Fluency in the language of medicine
17. Which is a professional member of the healthcare team who provides servies or supplies
to the insured? - correct answer -Healthcare provider
18. Which is the universal claim form used by physicians offices? - correct answer -Centers
of Medicare and Medicaid Services-150 (CMS-1500)
19. Which document is mailed by the payer to the patient to illustrate the reimbrsement
amount of a covered benefit? - correct answer -Explanation of Benefits
, 20. Which term means the patient is not responsible for paying for what the insurance plan
denies? - correct answer -Hold Harmless Clause
21. Which document communicates to the payer that the provider is requesting
reimbursement? - correct answer -Health Insurance Claim
22. Which professional association was founded to eleate the standards of medical coding
by providing certification, ongoing education, networking, and recognition for coders? -
correct answer -American Academy of Professional Coders (AAPC)
23. Which professioinal association was founded to improve the quality of medical records
and current advances toward an electronic and global environment including the
implementation of ICD-10-CM - correct answer -American Health Information
Managment Association (AHIMA)
24. Which is a legal term that indicates that providers responsibility for their employees
actions and omissions - correct answer -...
25. Blue Cross Blue Shield (BCBS) - correct answer -joint venture between Blue Cross and
Blue shield where the corporations shared one building and computer services but
maintained seperate corporate identities.
BILLER CERTIFICATION EXAM 2025/
2026 QUESTIONS WITH VERIFIED
ANSWERS
1. beneficiary counseling and assistance coordinator (BCAC) - correct answer -individual
available at military treatment facility (MTF) to answer questions, help solve healthcare
related problems, and assist beneficiaries in obtaining medical care through TRICARE;
was previously called health benefits advisor (HBA)
2. benefit period (Medicare) - correct answer -begins with the first day of hospitalization
and ends when the patient has been out of the hospital for 60 consecutive days.
3. benign - correct answer -not cancerous
4. billing entity - correct answer -the legal business name of the provider's pratice.
5. birthday rule - correct answer -determines coverage by primary and secondary policies
when each parent subscribes to a different health insurance plan.
,6. black box edits - correct answer -nonpublished code edits, which were discontinued in
2000.
7. BlueCard Program - correct answer -program that allows BCBS subscribers to receive
local Blue Plan healthcare benefits while traveling or living outside of their plan's area.
8. Blue Cross (BC) - correct answer -insurance plan created in 1929 when Baylor University
Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that
guaranteed up to 21 days of hospitalization per year for subscribers and each dependent
for a $6 annual premium.
9. Blue Cross Blue Shield (BCBS) - correct answer -joint venture between Blue Cross and
Blue Shield where the corporation shared one building and computer
10. The coding system currently in use to report diagnoses and reasons for encounter is the:
- correct answer -International Classification of Diseases, 9th revision, clinical
modification (ICD-9-CM)
11. The person who prepares and reviews claims for accuracy to ensure prompt payment is
the : - correct answer -Health Insurance Specialist
12. Medical Ethics are: - correct answer -Principles of right or good conduct
,13. A person who performs services for another under an expressed or implied agreement is
called a(n): - correct answer -Independent Contractor
14. Which is an authorization that must be received from a payer before treatment by a
specialist wil be covered? - correct answer -Preauthorization
15. Which coding systerm is used to report professional services to payers? - correct answer
-Current Procedural Terminology (CPT)
16. Which is a crucial skill that all health insurance specialists should learn in their training
coursework? - correct answer -Fluency in the language of medicine
17. Which is a professional member of the healthcare team who provides servies or supplies
to the insured? - correct answer -Healthcare provider
18. Which is the universal claim form used by physicians offices? - correct answer -Centers
of Medicare and Medicaid Services-150 (CMS-1500)
19. Which document is mailed by the payer to the patient to illustrate the reimbrsement
amount of a covered benefit? - correct answer -Explanation of Benefits
, 20. Which term means the patient is not responsible for paying for what the insurance plan
denies? - correct answer -Hold Harmless Clause
21. Which document communicates to the payer that the provider is requesting
reimbursement? - correct answer -Health Insurance Claim
22. Which professional association was founded to eleate the standards of medical coding
by providing certification, ongoing education, networking, and recognition for coders? -
correct answer -American Academy of Professional Coders (AAPC)
23. Which professioinal association was founded to improve the quality of medical records
and current advances toward an electronic and global environment including the
implementation of ICD-10-CM - correct answer -American Health Information
Managment Association (AHIMA)
24. Which is a legal term that indicates that providers responsibility for their employees
actions and omissions - correct answer -...
25. Blue Cross Blue Shield (BCBS) - correct answer -joint venture between Blue Cross and
Blue shield where the corporations shared one building and computer services but
maintained seperate corporate identities.
