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Exam Code: CPB
Exam Name: Certified Professional Biller (CPB)
Updated: Aug 13, 2026
Q & A: 245 Questions and Answers
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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Types of Insurance | 21% | - Medicare, Medigap, Medicaid - Commercial payers - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Third-party liability |
| Topic 2: Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| Topic 3: Claims and Billing | 14% | - Denials, appeals, corrections - Claim submission, tracking, follow-up - Electronic claims, clearinghouses - Timely filing rules |
| Topic 4: Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management |
| Topic 5: Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Topic 6: HIPAA and Compliance | 9% | - Compliance programs - Privacy, security, transaction standards - Medical record retention - Fraud, abuse, False Claims Act |
| Topic 7: Billing Regulations | 13% | - Incident-to billing, global packages - CMS-1500, UB-04 completion - Payer payment policies - ACOs, NCCI, LCDs, NCDs |
1. HIPPS stands for Health Insurance Prospective Payment System (code set).
A) TRUE
B) FALSE
2. ABN stands for Advance Beneficiary Notice.
A) TRUE
B) FALSE
3. DOD
A) Diagnosis related groups
B) Diagnostic and statistical manual
C) Department of Defense
D) Disproportionate share hospital (adjustment)
4. CSCP
A) Computed Tomography
B) Customized SubCapitation Plan
C) Defense Enrollment Eligibility Reporting System
D) Debt Collection Assistance Officer
5. Which entity is responsible for enforcing HIPAA privacy regulations?
A) CMS
B) Office for Civil Rights (OCR)
C) Office of Inspector General (OIG)
D) American Medical Association (AMA)
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: A | Question # 3 Answer: C | Question # 4 Answer: B | Question # 5 Answer: B |
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