Free Practice Questions for CPB Medical Billing

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Exam Review

Key Facts: CPB Medical Billing Exam

100+

Practice Questions Here

OpenExamPrep CPB bank

70%

Passing Score

AAPC CPB exam

Exam Duration

AAPC CPB format

AAPC

Credentialing Body

American Academy of Professional Coders

2026

Content Refresh

Current billing rules

Revenue Cycle

Core Focus

Full RCM workflow

The AAPC CPB exam has 100 multiple-choice questions with a 4-hour time limit, requiring 70% to pass. It covers the full medical billing revenue cycle including insurance basics, claim submission (CMS-1500/837P), payer-specific rules (Medicare, Medicaid, commercial), payment posting, denial management, compliance (HIPAA, FCA, Stark, AKS), and electronic transactions (835, 270/271, 276/277). AAPC membership is required to sit for the exam.

Sample CPB Medical Billing Practice Questions

Try these sample questions to review concepts for the CPB Medical Billing exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1What is the primary purpose of the CMS-1500 claim form in medical billing?

A.To submit professional/physician service claims to payers

B.To submit hospital inpatient claims

C.To report quality measures to CMS

D.To request prior authorization

Explanation: The CMS-1500 (also known as the HCFA-1500) is the standard paper claim form used to submit professional and physician service claims to insurance payers. The UB-04 (CMS-1450) is used for facility/institutional claims. Exam Tip: Most claims are now submitted electronically (837P), but understanding the CMS-1500 form fields is essential for the CPB exam.

2Which electronic transaction standard is used for submitting professional claims under HIPAA?

A.837P (Professional)

B.837I (Institutional)

C.835 (Remittance Advice)

D.270/271 (Eligibility)

Explanation: The HIPAA 837P transaction is the electronic format for submitting professional healthcare claims. 837I is for institutional claims, 835 is for electronic remittance advice (ERA), and 270/271 is for eligibility inquiries and responses. Exam Tip: Know the major HIPAA transaction code sets — 837P, 837I, 835, 270/271, 276/277, and 278.

3A patient's insurance company denies a claim with reason code CO-4. What does this denial indicate?

A.The procedure code is inconsistent with the modifier used or a required modifier is missing

B.The service is not covered under the patient's benefit plan

C.The claim was submitted after the timely filing deadline

D.The patient has not met the annual deductible

Explanation: Claim Adjustment Reason Code (CARC) CO-4 indicates that the procedure code is inconsistent with the modifier used, or a required modifier is missing. The 'CO' group code means the provider is contractually responsible for the adjustment. Exam Tip: Familiarize yourself with common CARCs and Remittance Advice Remark Codes (RARCs) for the CPB exam.

4What is the difference between a deductible and a copayment in health insurance?

A.A deductible is the amount the patient must pay before insurance begins to cover services; a copayment is a fixed amount paid per visit or service

B.A deductible and copayment are the same thing

C.A copayment is paid before insurance begins; a deductible is paid per visit

D.Neither applies to professional billing

Explanation: A deductible is the annual amount a patient must pay out-of-pocket before the insurance plan begins paying for covered services. A copayment (copay) is a fixed dollar amount the patient pays at each visit or for each service. Both are forms of cost-sharing. Exam Tip: Also understand coinsurance, which is a percentage of the allowed amount the patient pays after the deductible is met.

5Which regulation prohibits billing Medicare and the patient for charges above the Medicare-approved amount for participating providers?

A.The Medicare participation agreement (accepting assignment)

B.The False Claims Act

C.The Anti-Kickback Statute

D.The HIPAA Privacy Rule

Explanation: Participating providers agree to accept the Medicare-approved amount as payment in full and cannot balance bill the patient beyond the deductible and coinsurance. This is part of the Medicare participation agreement. Exam Tip: Non-participating providers may charge up to the limiting charge (115% of the non-par fee schedule amount).

6What does EOB stand for in medical billing?

A.Explanation of Benefits

B.Estimation of Billing

C.Evidence of Benefits

D.Evaluation of Benefits

Explanation: EOB stands for Explanation of Benefits, which is a statement sent to the patient and/or provider by the insurance company after a claim is processed. It details what was billed, what was allowed, what the insurance paid, and what the patient owes. Exam Tip: An EOB is not a bill; it is an explanation of how the claim was processed. The provider sends a patient statement for any remaining balance.

7When a patient has coverage under two insurance plans, which concept determines the order of payment?

A.Coordination of Benefits (COB)

B.Prior Authorization

C.Medical Necessity Determination

D.Utilization Review

Explanation: Coordination of Benefits (COB) is the process that determines which insurance plan pays first (primary) and which pays second (secondary) when a patient has dual coverage. COB rules follow guidelines established by the NAIC and vary by situation (employment status, dependent coverage, etc.). Exam Tip: The Birthday Rule is commonly used for determining primary coverage for dependent children.

8What is the purpose of a prior authorization in medical billing?

A.To obtain approval from the insurance company before a service is rendered to confirm coverage

B.To verify the patient's identity

C.To submit a claim for payment

D.To appeal a denied claim

Explanation: Prior authorization (also called precertification or preauthorization) is the process of obtaining approval from the insurance payer before performing a service or procedure. Failure to obtain required prior authorization can result in claim denial. Exam Tip: Prior authorization does not guarantee payment; it confirms the service is covered but actual payment still depends on claim accuracy and medical necessity.

9Which CMS-1500 form field is used to enter the patient's diagnosis codes?

A.Box 21

B.Box 24D

C.Box 33

D.Box 17

Explanation: Box 21 on the CMS-1500 form is where ICD-10-CM diagnosis codes are entered. Up to 12 diagnosis codes can be listed. Box 24D is for procedure codes, Box 33 is for the billing provider's information, and Box 17 is for the referring provider. Exam Tip: Diagnosis pointer letters (A-L) in Box 24E link each service line to the applicable diagnosis code(s) in Box 21.

10A patient presents with Medicare as primary insurance and a commercial plan as secondary. After Medicare processes the claim, what is the next step?

A.Submit the remaining balance to the secondary insurance with the Medicare remittance information

B.Bill the patient for the full remaining balance

C.Write off the remaining balance

D.Resubmit the claim to Medicare for additional payment

Explanation: When a patient has Medicare as primary and a secondary commercial plan, the claim is first processed by Medicare. The remaining balance (deductible, coinsurance) is then submitted to the secondary payer along with Medicare's remittance information (EOB/ERA). Exam Tip: Many clearinghouses support automatic crossover to secondary payers after Medicare adjudication.

About the CPB Medical Billing Exam

The CPB credential from AAPC is the industry-standard medical billing certification. It validates expertise across the entire revenue cycle — from patient registration and eligibility verification through claim submission, payment posting, denial management, and appeals. The exam covers insurance fundamentals, payer-specific billing rules, HIPAA compliance, and electronic transactions.

Exam sponsor: AAPC. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

100 questions

Time Limit

4 hours

Passing Score

70%

Exam / Certification Fees

$300 members / $400 non-members

Exam sponsor website

Reported exam pass rate: ~65-70%. estimated (AAPC does not publish official rates) This describes exam candidates, not OpenExamPrep users or results from using our resources. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

High

Revenue Cycle and Claim Submission

Full RCM workflow from registration through collections, CMS-1500/837P fields, and adjudication

High

Payer-Specific Billing Rules

Medicare, Medicaid, commercial, TRICARE, workers' comp, and specialty payer requirements

Medium

Denial Management and Appeals

Denial analysis, corrected claims, appeal levels, and A/R management strategies

Medium

Compliance and Regulations

HIPAA, False Claims Act, Anti-Kickback, Stark Law, ABN, and billing compliance programs

Foundation

Insurance Fundamentals and Coding Basics

Plan types, cost-sharing, COB, and coding knowledge essential for billing accuracy

Preparing for the CPB Medical Billing Exam

What You Need to Know

Passing score: 70%
Exam length: 100 questions
Time limit: 4 hours
Exam / certification fees: $300 members / $400 non-members Official sources

Using Our Practice Resources

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

CPB Medical Billing: Suggested Study Strategy

1Master the revenue cycle from start to finish — patient registration through final payment and collections

2Know the CMS-1500 form fields inside and out, especially boxes 21, 24A-J, 27, and 33

3Study Medicare-specific rules: participation, ABN requirements, timely filing, and fee schedule calculations

4Practice claim denial scenarios with CARCs, RARCs, and group codes (PR, CO, OA)

5Understand all HIPAA electronic transactions: 837P, 835, 270/271, 276/277, and 278

Frequently Asked Questions

What is the CPB exam format?

The AAPC CPB exam consists of 100 multiple-choice questions with a 4-hour time limit. A score of 70% or higher is required to pass. The exam is delivered electronically via live remote proctoring or at a testing center. AAPC membership is required.

What score do I need to pass the CPB exam?

You need 70% (70 correct answers out of 100) to pass the AAPC CPB exam. The exam covers medical billing topics including revenue cycle management, payer rules, claim submission, denial management, and compliance.

How should I study for CPB in 2026?

Focus on the revenue cycle workflow, insurance fundamentals (plan types, cost-sharing, COB), CMS-1500/837P claim forms, Medicare/Medicaid billing rules, denial management processes, and compliance regulations (HIPAA, FCA, Stark Law). Practice with scenario-based questions.

What is the difference between CPB and CPC?

CPB (Certified Professional Biller) focuses on the business side of healthcare — billing, claims, revenue cycle, payer rules, and compliance. CPC (Certified Professional Coder) focuses on the clinical coding side — CPT, ICD-10-CM, and HCPCS code assignment from documentation. Many professionals hold both credentials.

Is CPC required before taking CPB?

No. CPC and CPB are independent certifications. You can take CPB without having CPC. However, some CPB exam content involves coding fundamentals, so basic familiarity with ICD-10-CM and CPT is helpful.

What career opportunities does CPB open?

CPB-certified professionals work in medical billing departments, revenue cycle management, insurance follow-up, denial management, payment posting, patient financial services, and billing management roles across physician practices, hospitals, and billing companies.

Can I take the CPB exam remotely?

Yes. AAPC offers the CPB exam via live remote proctoring (LRP) through Meazure Learning/ProctorU, in addition to testing center delivery. You need a computer with webcam, microphone, and stable internet connection.

Free Practice Questions for CPB Medical Billing

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