AAPC CPB CERTIFIED PROFESSIONAL BILLER
EXAM 2026 VERIFIED QUESTIONS AND
DETAILED SOLUTIONS
◉ Pioneer. Answer: A healthcare organization with 2 hospitals, 20
clinics, and 3 urgent care centers belongs to an ACO program. They
have been in the shared savings program for two years and are now
eligible to move large payments to a population-based model as they
have been successful in keeping costs down and have met all the
CMS benchmarks set for them. What type of ACO is this?
◉ Medicare. Answer: What is the largest health program in the
United States?
◉ NPI. Answer: a unique 10-digit identification number required by
HIPAA
◉ All plans offer HMOs. Answer: Medicaid plans provide for low-
income families. Which statement regarding Medicaid is NOT
correct?
◉ credentialling. Answer: A new physician comes in to the practice
that is just out of medical school. He will need to be able to see
patients in the office and at the hospital. What process will he need
,to undergo in order to be able to participate with Medicare and
other health plans?
◉ group and sole proprietor. Answer: NPI numbers have two types
of entities - identify the two types:
◉ natl provider identifier. Answer: NPI:
◉ Home Health. Answer: Which of the following services is NOT
covered under Medicare Part B?
◉ 5000. Answer: ACOs are formed with ___ lives
◉ 100,000 +. Answer: HMOs are formed with ___ lives
◉ patient. Answer: When insurance coverage is being verified,
which of the following is NOT a method on which to rely?
◉ no charge. Answer: When a fee ticket (encounter form) is not
completed, what procedure would NOT be acceptable?
◉ verify benefits. Answer: Information about deductibles, copays,
eligibility dates, and benefit plans is completed during what step?
, ◉ birthday rule. Answer: determine primary and secondary
coverage
◉ auth for treatment. Answer: Which of the following is NOT
considered a part of the authorized process when the patient signs
the consent for payment?
◉ payer, ins type. Answer: Patient types help to classify the patients
based on
◉ submission
processing
adjudication
payment/denial. Answer: Life cycle of a claim:
◉ consent for payment. Answer: What authorizes information to be
sent to the insurance payer so payment of medical benefits can be
processed?
◉ deductible. Answer: Amount of expenses that must be paid before
any payment is made by the insurance company
◉ 3 letters then 9 numbers. Answer: BCBS member #:
EXAM 2026 VERIFIED QUESTIONS AND
DETAILED SOLUTIONS
◉ Pioneer. Answer: A healthcare organization with 2 hospitals, 20
clinics, and 3 urgent care centers belongs to an ACO program. They
have been in the shared savings program for two years and are now
eligible to move large payments to a population-based model as they
have been successful in keeping costs down and have met all the
CMS benchmarks set for them. What type of ACO is this?
◉ Medicare. Answer: What is the largest health program in the
United States?
◉ NPI. Answer: a unique 10-digit identification number required by
HIPAA
◉ All plans offer HMOs. Answer: Medicaid plans provide for low-
income families. Which statement regarding Medicaid is NOT
correct?
◉ credentialling. Answer: A new physician comes in to the practice
that is just out of medical school. He will need to be able to see
patients in the office and at the hospital. What process will he need
,to undergo in order to be able to participate with Medicare and
other health plans?
◉ group and sole proprietor. Answer: NPI numbers have two types
of entities - identify the two types:
◉ natl provider identifier. Answer: NPI:
◉ Home Health. Answer: Which of the following services is NOT
covered under Medicare Part B?
◉ 5000. Answer: ACOs are formed with ___ lives
◉ 100,000 +. Answer: HMOs are formed with ___ lives
◉ patient. Answer: When insurance coverage is being verified,
which of the following is NOT a method on which to rely?
◉ no charge. Answer: When a fee ticket (encounter form) is not
completed, what procedure would NOT be acceptable?
◉ verify benefits. Answer: Information about deductibles, copays,
eligibility dates, and benefit plans is completed during what step?
, ◉ birthday rule. Answer: determine primary and secondary
coverage
◉ auth for treatment. Answer: Which of the following is NOT
considered a part of the authorized process when the patient signs
the consent for payment?
◉ payer, ins type. Answer: Patient types help to classify the patients
based on
◉ submission
processing
adjudication
payment/denial. Answer: Life cycle of a claim:
◉ consent for payment. Answer: What authorizes information to be
sent to the insurance payer so payment of medical benefits can be
processed?
◉ deductible. Answer: Amount of expenses that must be paid before
any payment is made by the insurance company
◉ 3 letters then 9 numbers. Answer: BCBS member #:
