2024 Edition

Medical Biller Practice Test

Try this free medical billing practice test to see what's on a certification exam for medical billers.

Certification as a medical biller demonstrates one's knowledge and skill in the field of medical billing and can help one get a job as a medical biller and earn more in pay. The American Academy of Professional Coders (AAPC) provides training and credentialling for medical billers across the United States. After passing the AAPC medical billing exam, a medical biller earns the Certified Professinal Biller (CPB) credential. The medical biller exam must be passed to earn certificaiton. The medical billing exam has 135 multiple choice questions and four hours is given to complete the exam.

To prepare for the AAPC CPB exam, use our 500 Question Medical Billing Practice Exam.

For additional practice for medical coding, use our 500 Question Medical Coding Practice Exam.


Types of Insurance

1. Tricare is insurance for:
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2. Betty Jane has Medicare coverage. You explain to her that she cannot come to see Dr. Frank at the outpatient clinic for a simple skin cancer removal because she:
3. Farah has Medigap and pays out-of-pocket for this coverage. Which of the following will this plan cover?
4. Medicaid is administered by:
5. Which of the following is not a private insurance carrier?
6. A patient comes in with a piece of metal shavings in his eye that he got while welding at his job. He has Anthem health insurance through his work. Which of the following insurances would cover his visit?
7. The difference between an HMO and a PPO is:

Medical Billing Regulations

8. The time allowed to submit a claim to Medicare is:
9. A patient has medical coverage through IHS. To which of the following organizations would you most likely submit a claim?
10. Which act mandates the provision of emergency medical treatment in order to stabilize the patient, even if the patient cannot pay for it?
11. Which of the following regulations prohibits billing of invalid claims to government payers only?
12. Which of the following changes would be considered a criminal offense in medical billing?
13. What is the main objective of the Medicare Access and CHIP Reauthorization Act (MACRA)?
14. Under which law are out-of-network providers prohibited from balance billing patients for radiology fees?
15. The amount a provider charges the insurance company for services:
16. According to CMS, which form must be obtained and signed for Medicare beneficiaries receiving non-covered services before those services are rendered?
17. Marge has Medicaid and goes to see the chiropractor once a week. The chiropractor takes Medicaid but informs Marge that she has a $25 copay for each visit. Marge's insurance card lists no copay. When questioned, the billing office tells Marge that her insurance only reimburses $17 per chiropractic visit and it would cost them more to bill her insurance than it would just to have her pay--and it's only $25. According to Medicaid regulations:
18. A Medicare patient calls. She's been seeing Dr. Hamilton for 10 years for her chronic conditions. It's January and her furnace just broke and it will be $500--and she's on a fixed income and just can't swing the furnace and her Medicare deductible right now. She's going to have to make payments on the furnace as it is. She wants to know if there's any way you could give her a break and waive the deductible. How should the billing professional respond?

HIPAA and Compliance

19. Your neighbor's 17-year-old daughter was recently admitted to the hospital where you work in the billing department. The nurse told you that she's asleep and your neighbor is out of town, but you are curious what treatments she's received and want to make sure that she told the provider she is allergic to latex. What do you do?
20. A Medicare RAC sends you a letter demanding that you repay Medicare $1,500 for 10 patient accounts. You must:
21. What does the acronym HIPAA stand for?
22. Which part of HIPAA is primarily focused on protecting the privacy and security of health information?
23. The information of what number of patients must be improperly disclosed before the healthcare organization is required to contact the local news media?
24. A patient calls and asks that you send them their chart for their most recent visit. How much time do you have to send them their records?

Reimbursement and Collections

25. A provider bills $400 for a test. The insurance pays $300 and the patient's responsibility is $23.56. What is the contractual discount and what is the patient's responsibility called?
26. Capitation payments in healthcare are:
27. What is a case mix index?
28. Per Diem codes are reimbursed by:
29. What is a clearinghouse and what purpose do they serve?
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30. A _____ is a monthly payment to purchase and continue insurance coverage. A _______ is how much money you must pay before your insurance begins to pay for medical services. A _____ is a flat fee you must pay every time you see the doctor and _______ is a percentage you must pay in addition to other fees.
31. You are reading a Medicare RA. You see that Medicare has allowed the full amount but paid nothing. The total allowed amount is $145. The claims adjustment reason code reads CO-1. What do you do?
32. What is a RVU and why is it important?

Medical Billing

33. A patient has cataract surgery, which has a 90-day global period. The patient's date of surgery was 1/1 and their date of transfer was 1/2. If you are billing CMS for post-operative care only, what dates must you put in which box?
34. If you are submitting a corrected claim, you must do the following:
35. Sarah bills for the outpatient department for a hospital, where they are paid under the outpatient prospective payment system. Sarah reviews a patient's account to begin the billing process and sees an emergency department visit that includes lab work, an EKG, IV medication, and a simple surgery. Which item will not be reimbursed if Sarah bills for it?
36. Daphne works at a doctor's office and submits a claim for an office visit for post-partum complications right after the patient has given birth. What is the most likely reason for this claim being denied?
37. In EMC ANSI 837, what are the boxes that were on CMS-1500 now called?
38. If the information on CMS 1500 in 24J is the same individual as the information in 32a, what is the most likely cause?
39. If a patient has both Medicare and Aetna, which insurance do you bill?
40. What is a valid POS for an office?
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Medical Coding

41. When using a 50 modifier on a claim instead of using RT and LT on a claim, remember that:
42. Which of the following is true about code J4010?
43. Which of the following codes are most likely to be NOT included in a code for an arm fracture reduction surgery?
44. Dr. Smith sees a child patient for 15 minutes, then speaks to their parent for 45 minutes, carefully detailing instructions for the child's care. If Dr. Smith is in an office, which code would be used for this service?
45. If a distinct evaluation and management service is billed with an injection, what modifier must be attached?
46. A patient gets blood work done. They receive blood work that tests: CMP, albumin, urea, potassium, chloride, creatinine and glucose. Everything but the CMP is denied. Why?
47. A patient comes in for a consultation on back pain and ends up scheduling the surgery for next week. What modifier should be added to the evaluation and management service?
48. A patient comes in for a follow up on their dressing. Three days before the patient had an incision and drainage of a hematoma from their wrist, which was paid by the insurance. The follow up visit was denied. Why?
49. A patient calls in, upset about their bill. They say they've been billed twice for the X-ray that they received last month. You review the patient's chart and see that they have indeed been charged the same code twice, one with TC and one with 26 modifiers. Why is this?
50. What difference is there between inpatient and pro-fee coding and the way it is reimbursed?

Quality starts with who wrote the material.
Our practice exam writer
Mandy Colligan,
 is an assistant professor of Health Information Management at the Community College of Allegheny County in Pittsburgh, Pennsylvania and is a remote adjunct professor at Ramussen College in Minnesota. Mandy has been working in medical coding and billing for over fifteen years as a senior medical coder, manager of operations and revenue cycle and coding manager.

Carol Maimone,
 is an assistant professor and program coordinator in medical billing and coding at the State University of New York, Schenectady.  Before SUNY, Carol taught medical coding and billing at Highline Community College, in Wisconsin and at the Mildred Elley School in New York. She has been working in the medical coding field for over ten years as a DRG Analyst, HIM Director and Coding Validation Specialist.

Pamela Davis,
 is an adjunct instructor in medical coding and billing at Trident University in California.
She previously taught medical coding and billing and health information technology at Northwestern College in Illinois, the Colorado Technical University and UMA in Tampa, Florida.  Pamela has worked in the field of healthcare for over twenty years as an emergency room registrar, Medicare Specialist and Coding Abstractor and medical coder/auditor.
Our Medical Coding Practice Test follows the actual exam outline of the AAPC:

- Medical Terminology
- Anatomy
- Compliance and Regs
- Coding Guidelines
- ICD-10-CM
- HCPCS Level II
- 10,000 Series
- 20,000 Series
- 30,000 Series
- 40,000 Series
- 50,000 Series
- 60,000 Series
- Radiology Codes
- Pathology Codes
- Laboratory Codes
- Medicine
- E/M
- Anesthesia
- Case Studies