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Examen

AAPC CPB Practice Exam 2026/2027 | 250+ Questions & Answers | Medicare, Medicaid, HIPAA, Claims, Coding & Compliance

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This AAPC Certified Professional Biller (CPB) practice exam provides 250+ exam-style questions and correct answers for 2026/2027, covering core professional medical billing topics such as Medicare and Medicaid, HIPAA and patient privacy, managed-care plans, coordination of benefits, claims processing, CMS-1500 and UB-04 billing, reimbursement, prior authorization, appeals and denials, provider credentialing, accounts receivable, patient collections, fraud and abuse, CPT/HCPCS coding concepts, modifiers, and billing compliance. The material combines multiple-choice practice questions with direct question-and-answer review sections, making it suitable for comprehensive CPB certification preparation and targeted revision of frequently tested billing concepts. The document also addresses practical revenue-cycle situations, including insurance eligibility verification, timely filing, medical necessity, Medicare secondary payer rules, Medigap claims, workers' compensation, participating versus nonparticipating providers, deductibles, copayments, coinsurance, overpayments, Advance Beneficiary Notices, NCCI-related billing issues, and federal healthcare fraud and abuse requirements. Students can use the questions to reinforce their understanding of payer policies, compliant claim submission, reimbursement procedures, and the administrative responsibilities encountered in professional medical billing. Reference alignment: The document is designed around AAPC CPB subject matter and repeatedly references U.S. billing standards and regulations associated with CMS, Medicare, Medicaid, HIPAA, CPT, HCPCS Level II, ICD-10-CM, the False Claims Act, and other federal healthcare requirements. The uploaded document itself does not provide a complete bibliographic reference to a specific AAPC textbook or peer-reviewed journal, so attributing it to a particular book or journal would not be accurate based solely on the source provided. Relevant students: This material is particularly relevant for students preparing for the AAPC Certified Professional Biller (CPB) examination, medical billing and coding students, health information management students, healthcare administration students, revenue-cycle and reimbursement students, and entry-level billing professionals seeking practice with U.S. healthcare insurance and claims procedures. Keywords: AAPC CPB practice exam, CPB practice questions, CPB exam questions and answers, Certified Professional Biller exam, CPB 2026, CPB 2027, medical billing exam, medical billing practice questions, Medicare billing, Medicaid billing, HIPAA compliance, CMS 1500, UB 04, medical claims processing, claim denials and appeals, coordination of benefits, healthcare reimbursement, medical billing compliance, CPT modifiers, HCPCS Level II, insurance verification, revenue cycle management, provider credentialing, fraud and abuse, medical billing certification

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AAPC CPB Practice Exam
2026/2027 Exam Questions and
Correct Answers | New Update



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.

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.

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

,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


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.



3
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2026. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED

, 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.

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


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

Información del documento

Subido en
19 de agosto de 2026
Número de páginas
137
Escrito en
2026/2027
Tipo
Examen
Contiene
Preguntas y respuestas
$18.99

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