AAPC Certified Professional Biller (CPB) Examination Practice Test
Medical billing connects patient and insurance information with claim submission, payer review, payment posting, and account follow-up. This practice page samples billing-office decisions involving eligibility identifiers, electronic transactions, remittance advice, claim edits, medical necessity, filing limits, recoupments, and accurate patient-account posting.
Exam overview
About the AAPC Certified Professional Biller (CPB) Examination Exam
CPB practice requires tracking a claim through its full revenue-cycle path: verify coverage details, assemble accurate billing data, submit claims, interpret payer responses, and resolve outstanding balances. Billing staff must distinguish a request for additional documentation from a denial, use remittance information to post payments and adjustments, and investigate underpayments or recoupments against the claim record. Other decisions involve checking whether a service is separately payable under bundling rules, correcting discrepancies between codes and documentation before submission, and recognizing when a payer policy affects medical necessity. Account-level accuracy also matters: staff need to reconcile payment records, identify misapplied amounts, and preserve a clear audit trail while correcting errors. These tasks combine transaction knowledge, policy review, documentation control, and careful communication with patients, providers, and payers.
Sample Practice Questions
Review a selection from this exam's published US Practice Tests practice bank.
A patient’s insurance card shows a group number and a member identification number. Which information is most useful for locating the patient’s enrollment record with the plan?
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Correct answer: AThe member identification number is a key identifier for locating coverage, and payer systems may also require demographic details for verification. Provider identifiers and appointment details do not substitute for the member’s enrollment identifiers.
A provider’s office needs to submit an electronic claim for payment to a health plan. Which transaction is generally used for this purpose under HIPAA-adopted standard transactions?
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Correct answer: AThe 837 transaction is used to submit health care claims electronically. The 835 is used for payment and remittance advice, the 270 for eligibility inquiries, and the 276 for claim status inquiries.
A billing office receives a request from a payer for additional information before it can complete claim review. What should staff generally do?
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Correct answer: BStaff should identify the specific information requested, ensure the submission is relevant and accurate, and use the payer’s designated method and timeframe. This supports appropriate claim review and avoids unnecessary disclosure.
A practice receives an electronic remittance advice (ERA) from a payer. What is its primary purpose?
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Correct answer: BAn ERA communicates claim adjudication details, such as amounts paid, denied, or adjusted and associated reason codes. It supports payment posting and follow-up on unpaid or disputed amounts.
A claim contains a billed service that is included in another service under the payer’s bundling rules. What should the biller review before seeking separate payment for it?
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Correct answer: ABundling rules may treat certain services as included in a larger service, while recognized exceptions may permit separate reporting when supported by documentation and applicable coding rules. The biller should verify the relevant policy rather than assume separate payment is allowed.
A payer issues a recoupment notice stating that it previously paid a claim in error. What should the billing office generally do first?
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Correct answer: AA recoupment should be researched against the original claim and payment records, and the office should follow the payer’s stated response or dispute procedure. Records should be retained, and patient liability should not be assumed without review.
A claim includes a procedure code that does not match the service documented in the medical record. What should the billing team do before submitting the claim?
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Correct answer: BA claim should accurately reflect the service documented. The biller should review the record and code selection, then resolve any discrepancy before submission rather than guessing or altering documentation.
How to use this practice test
Access is free. A session draws up to 20 random questions from the available 50-question bank and displays results after completion. Use the questions to practice claim follow-up, payer-response interpretation, and billing accuracy; review any missed decisions against the relevant transaction, documentation, or account record.
Preparation tips
- Practice identifying the purpose of common HIPAA-adopted transactions, especially electronic claim submission and payer remittance information.
- For claim scenarios, trace the sequence from eligibility and documentation checks through submission, payer response, and account posting.
- Compare billed services with documentation and payer bundling or medical-necessity rules before deciding whether to correct, appeal, or seek separate payment.
- For denials, information requests, filing-limit issues, and recoupments, identify the payer’s stated reason and the records needed for follow-up.
- Work through payment-posting examples carefully, matching patient identifiers and claim details before applying funds or adjustments.