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2026 Edition

Medical Biller Practice Test

Try this free AAPC CPB medical billing practice test to study for your medical biller certification exam. Our medical billing test prep is written by certified instructors in medical billing. For a comprehensive practice test, use our 500 question Medical Billing Practice Exam.  To add medical coding to your practice, use our 600 question Medical Coding Practice Exam. 

Types of Insurance 

1 Tricare is insurance for:
Incorrect. Please choose another answer.
Tricare covers active duty service members and their families and also surviving spouses and retired active duty service members under certain plans.

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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:
Incorrect. Please choose another answer.
Medicare only covers inpatient hospital stays under Medicare Part A, and additional coverage must be purchased for Medicare Part B, which would cover an outpatient and physician office visit.
3 Farah has Medigap and pays out-of-pocket for this coverage. Which of the following will this plan cover?
Incorrect. Please choose another answer.
Medigap only covers what original Medicare covers, but will cover deductibles, copays and coinsurance. Medigap does not cover prescription drugs or anything else that traditional Medicare does not cover.
4 Medicaid is administered by:
Incorrect. Please choose another answer.
Medicaid is administered by the state governments, in accordance with federal requirements, and is for low income, disabled or individuals with complex medical needs and has a sub-section for a children's insurance plan in some states.

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5 Which of the following is not a private insurance carrier?
Incorrect. Please choose another answer.
CMS is Centers for Medicare and Medicaid which is run by the government and not private insurance.
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?
Incorrect. Please choose another answer.
The worker/patient must fill out a worker's compensation claim. His private insurance will not cover a work-based injury. The insurance company will be notified because there is a specific box on the CMS-1500 form that asks whether this injury was related to work.
7 The difference between an HMO and a PPO is:
Incorrect. Please choose another answer.
PPO plans cover out of network visits, but usually at a significantly reduced rate, e.g. 50% coverage instead of 80%. HMO plans do not allow for visits out of network.

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Medical Billing Regulations 

8 The time allowed to submit a claim to Medicare is:
Incorrect. Please choose another answer.
365 days or 1 year is timely filing for Medicare. Other insurances, such as Humana, have shorter timely filing periods of 90 days. Claims can be submitted to Medicare after 1 year but will be denied for timely filing limit and no payment will be received.
9 A patient has medical coverage through IHS. To which of the following organizations would you most likely submit a claim?
Incorrect. Please choose another answer.
The Muscogee Nation Health System is part of the Indian Health Service (IHS). Patients who have IHS coverage will have their claim often submitted directly to the tribe for payment.
10 Which act mandates the provision of emergency medical treatment in order to stabilize the patient, even if the patient cannot pay for it?
Incorrect. Please choose another answer.
Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to provide emergency medical treatment to individuals regardless of their insurance status or ability to pay. It ensures that emergency services are provided during critical situations without financial discrimination, however it only provides enough coverage to stabilize the patient.

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11 Which of the following regulations prohibits billing of invalid claims to government payers only?
Incorrect. Please choose another answer.
The False Claims Act imposes criminal penalties for falsely submitted claims to government payers. It does not cover commercial payers, only payers that receive money from the federal government. Penalties can be severe and may result in millions of dollars of fines or even jail time.
12 Which of the following changes would be considered a criminal offense in medical billing?
Incorrect. Please choose another answer.
Bilateral codes are inherently two-sided. Adding a modifier to the code to get two bilateral codes paid for the same procedure would be a false claim and subject to possible criminal penalties.
13 What is the main objective of the Medicare Access and CHIP Reauthorization Act (MACRA)?
Incorrect. Please choose another answer.
MACRA changes how Medicare Part B providers are paid, shifting the focus from a fee-for-service model to a value-based care model, where providers are rewarded based on the quality and effectiveness of the care they provide.

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14 Under which law are out-of-network providers prohibited from balance billing patients for radiology fees?
Incorrect. Please choose another answer.
The purpose of the No Surprises Act is to give protection to patients for unexpected medical bills, in particular, out-of-network providers in emergency situations or at in-network facilities without the patient giving consent. This act restricts excessive out-of-pocket costs to patients from surprise billing. This only applies to certain provider types, like radiology, ambulance and laboratory.
15 The amount a provider charges the insurance company for services:
Incorrect. Please choose another answer.
A usual and customary amount (U&C) must be set and charged the same amount to all insurance carriers. The U&C amount can change and should be set to higher than the highest paying insurance company in order to capture complete reimbursement.
16 According to CMS, which form must be obtained and signed for Medicare beneficiaries receiving non-covered services before those services are rendered?
Incorrect. Please choose another answer.
An advance beneficiary notice (ABN) must be filled out before a patient receives non-covered services. This form must include a breakdown of all costs and the reason why it will not be covered. CMS-1500 is used to submit claims and beneficiaries never see it.

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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:
Incorrect. Please choose another answer.
It is illegal to bill Medicaid patients without signed consent. The chiropractor should refund her money and bill her insurance properly. Even if a service is not covered when billed to Medicaid, the balance cannot be billed to the patient afterwards.
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?
Incorrect. Please choose another answer.
According to the OIG, you may waive the patient's deductible for Medicare if the patient demonstrates financial hardship. You must keep a record of this form in the patient's records.

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?
Incorrect. Please choose another answer.
Accessing your neighbor's daughter's information in the EHR violates HIPAA's minimum necessary requirement, where individuals only access the minimum amount of protected health information needed to do their job. In instances where there is a "break the glass" safety feature in your hospital's EHR, this may send an alert to compliance and you will be subject to discipline or a more serious employment action.

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20 A Medicare RAC sends you a letter demanding that you repay Medicare $1,500 for 10 patient accounts. You must:
Incorrect. Please choose another answer.
You do not actually have to do anything. You can refute the RAC letter and provide documentation, file an appeal or do nothing and the RAC will recoup their payments out of your next check from Medicare.
21 What does the acronym HIPAA stand for?
Incorrect. Please choose another answer.
HIPAA stands for Health Insurance Portability and Accountability Act. It was enacted in 1996 to protect individuals' health information while allowing the appropriate release health information needed to provide high-quality health care. Its latest revision was in 2002.
22 Which part of HIPAA is primarily focused on protecting the privacy and security of health information?
Incorrect. Please choose another answer.
Administrative Simplification sets national standards for electronic healthcare transactions and national identifiers for providers, health insurance plans, and employers. It also includes the Privacy Rule and Security Rule, which protect the confidentiality and integrity of health information.

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23 The information of what number of patients must be improperly disclosed before the healthcare organization is required to contact the local news media?
Incorrect. Please choose another answer.
According to the breach notification section of HIPAA, If 500 or more patients are exposed to a breach of their private information, the local news media must be contacted. Anything less than that would require the healthcare organization to report the breach to the Secretary of Health and Human Services.
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?
Incorrect. Please choose another answer.
Under the Privacy Rule, HIPAA allows for 30 days and an additional 30 days can be added to the time period if you inform the patient in writing.

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?
Incorrect. Please choose another answer.
Coinsurance is a percentage of the contractual allowance, while copays are a flat set amount. The contractual allowance is the amount the provider was reimbursed directly plus the patient's responsibility, so the contractual discount is the usual and customary amount (U&C) minus reimbursement and minus patient's responsibility.

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26 Capitation payments in healthcare are:
Incorrect. Please choose another answer.
Capitation is a way for healthcare service providers to be paid. For each enrolled person under this system, physicians are paid a set amount, per period of time, whether or not that person seeks care.
27 What is a case mix index?
Incorrect. Please choose another answer.
A case-mix index is the average Diagnosis-Related Group (DRG) weight for a facility. It is created by adding all the weights of each patient's DRG and dividing it by the number of patients. This indicates the average monthly payment that a hospital or facility can receive so they can plan financially.
28 Per Diem codes are reimbursed by:
Incorrect. Please choose another answer.
Per Diem codes are reimbursed per day. Some examples of per diem codes include partial hospitalization psychiatric codes, and some skilled nursing facility codes.

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29 What is a clearinghouse and what purpose do they serve?
Incorrect. Please choose another answer.
Clearinghouses collect claims data and send it in a lump file to each individual insurance for reimbursement. Clearinghouses also receive and distribute ERAs and can provide additional services, such as patient statements if requested, but do not provide collections services.
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.
Incorrect. Please choose another answer.
Premiums are paid monthly to insurance to continue coverage. Deductibles must be paid before insurance begins to pay for medical services. Copays are flat fees for each doctor's visit and coinsurance is a percentage of the allowed amount that must be paid in addition to copays and deductibles.
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?
Incorrect. Please choose another answer.
CO-1 means that the patient has not paid their deductible, so the allowed amount should be transferred to the patient for them to pay.
32 What is a RVU and why is it important?
Incorrect. Please choose another answer.
Relative value units are combined with GPCIs and conversion factors to create the Medicare Fee-for-Service fee schedule.

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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?
Incorrect. Please choose another answer.
Medicare requires date of transfer, not date of surgery, as the beginning of the post-operative period. This information goes in box 19.
34 If you are submitting a corrected claim, you must do the following:
Incorrect. Please choose another answer.
Use code 7 for replacement claims and use the original claim number (ICN) in that box.
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?
Incorrect. Please choose another answer.
Lab work is considered bundled under the outpatient prospective payment system when ordered in the emergency department. All other items, the evaluation and management code, the surgery and IV medication may be separately payable with the proper codes.
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?
Incorrect. Please choose another answer.
Post-partum visits have a 42 day postpartum global period, so no office visits relating to the patient's pregnancy may be billed. The patient needs to continue to see their OB-GYN for continuity of care.
37 In EMC ANSI 837, what are the boxes that were on CMS-1500 now called?
Incorrect. Please choose another answer.
Loops and segments crosswalk to CMS-1500 boxes.

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38 If the information on CMS 1500 in 24J is the same individual as the information in 32a, what is the most likely cause?
Incorrect. Please choose another answer.
The provider is enrolled as a sole proprietor and only has an individual NPI. Sole proprietors can use their individual NPI as both a group and an individual NPI, but if they ever hire someone it makes billing a bit messy. The group could also be put into box 24J, but since we're talking about individuals and not organizations, this is not the most likely cause.
39 If a patient has both Medicare and Aetna, which insurance do you bill?
Incorrect. Please choose another answer.
Medicare is always primary and Medicare will send an RA to Aetna (which may or may not make it, so it's always good to follow up with another claim and COB to Aetna after receiving your remit from Medicare).
40 What is a valid POS for an office?
Incorrect. Please choose another answer.
11 is the Place of Service (POS) that is billed for an office. 12 POS is a home visit.

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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:
Incorrect. Please choose another answer.
A 50 Modifier is a payment modifier. RT and LT codes are informational only, and are not required to be billed with a 50 modifier. RT and LT codes are used when a unilateral code is billed to indicate it was done on more than one side and do not affect the payment of the code. 50 modifiers, however, increase reimbursement by 150% for a single line of code.
42 Which of the following is true about code J4010?
Incorrect. Please choose another answer.
J4010 is a drug code. All drugs are included in HCPCS Level II under the "J" section and can be found by the table in the front of the HCPCS Level II book.
43 Which of the following codes are most likely to be NOT included in a code for an arm fracture reduction surgery?
Incorrect. Please choose another answer.
Per CMS NCCI policy, anesthesia is not covered as part of a fracture reduction. However, casting of the arm, lidocaine for pain, and debridement of bone fragments are all included in the surgical procedure.

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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?
Incorrect. Please choose another answer.
E/M guidelines indicate to use 99417 when an evaluation and management service exceeds 55 minutes. Here, when speaking to the patient's caregiver, we can include that time in the leveling of the service.
45 If a distinct evaluation and management service is billed with an injection, what modifier must be attached?
Incorrect. Please choose another answer.
A 25 modifier must be attached to the evaluation and management if documentation supports and it was a significant and separate service apart from the injection.
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?
Incorrect. Please choose another answer.
Comprehensive metabolic panel includes Albumin, Bilirubin, Calcium, Carbon dioxide Chloride, Creatinine, Glucose, Phosphatase, Potassium, Protein, Sodium, ALT, AST, BUN. This is an example of unbundling.

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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?
Incorrect. Please choose another answer.
Modifier 57 indicates that the evaluation and management service resulted in a decision for surgery.
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?
Incorrect. Please choose another answer.
The procedure has a 90 day global period. The global payment covers all related procedures to the initial procedure within those 90 days, including dressing changes.
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?
Incorrect. Please choose another answer.
One charge is for the facility and the other is for the reading of the X-ray. Radiologists (MDs) are not always the ones performing the actual X-ray, which is mostly X-ray technicians employed by the hospital. Then the radiologist both performs and interprets the X-ray and there is only one charge.

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50 What difference is there between inpatient and pro-fee coding and the way it is reimbursed?
Incorrect. Please choose another answer.
Professional fee visits are reimbursed on a fee schedule for each CPT code. ICD-10 CM diagnosis codes are not reimbursable in the professional setting but are grouped as Diagnosis Related Groups (DRGs) in inpatient setting and facility reimbursement is based off DRGs. ICD-10 PCS are procedure codes used in an inpatient setting but receive no reimbursement.
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Related Links

Quality starts with who wrote the material. Our writers:

Mandy Colligan, Medical Coding Instructor, 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.

Kateryna Patskovska, CPB-1, is an AAPC certified professional biller and AAPC Approved Instructor (CPB-1) with over 15 years of experience in the healthcare field. She is a published author in the AAPC HBM Magazine and produces educational webinars for the American Medical Billing Association.

Alena Stampfl, CPC, is an AAPC certified medical coder who is a medical coding and billling instructor at Lincoln Technical Institute in Paramus, New Jersey. She has over 15 years of experience in medical billing and coding, including practice management positions.

How should I study for the Medical Billing Exam?

Practice tests and flash cards are an effective way to study for the Medical Billing exam. They help you learn the subject matter and practice your test taking skills. Medical Biller exams, like that given by the AAPC, is taken on a computer, so practicing with online practice tests can boost your chance of success.

What is on a Medical Biller Certification Exam?

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 credentialing for medical billers across the United States. After passing the AAPC medical billing exam, a medical biller earns the Certified Professional Biller (CPB) credential. The medical biller exam must be passed to earn certification. The medical billing exam has 135 multiple choice questions and four hours is given to complete the exam.  The following content is covered by the AAPC medical billing exam:

- Types of Insurance
- Billing Regs
- HIPAA Compliance
- Reimbursements
- Collections
- Claims and Billing
- Coding
- Case Analysis
- CMS-1500 Claim Forms
- Payment Policies
- LCD
- NCD
- Appeal Letters
- Preauthorizations
- Pathology Codes
- Laboratory Codes
- Accounts Receivable
- Follow-up Reports
 
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