AAPC CPB Questions - Get Success In First Attempt (2026)

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AAPC CPB Exam Syllabus Topics:

Section	Weight	Objectives
Billing Regulations	13%	- ACOs, NCCI, LCDs, NCDs - Payer payment policies - Incident-to billing, global packages - CMS-1500, UB-04 completion
HIPAA and Compliance	9%	- Privacy, security, transaction standards - Medical record retention - Fraud, abuse, False Claims Act - Compliance programs
Claims and Billing	14%	- Claim submission, tracking, follow-up - Timely filing rules - Electronic claims, clearinghouses - Denials, appeals, corrections
Types of Insurance	21%	- Managed care plans - Medicare, Medigap, Medicaid - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Third-party liability
Coding Concepts for Billers	12%	- Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II
Case Analysis	17%	- Adjudication and resolution - Eligibility verification - End-to-end billing scenarios
Reimbursement and Collections	14%	- Payment posting, adjustments - Accounts receivable management - Patient statements, collections - Refunds, payment plans, write-offs

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AAPC Certified Professional Biller (CPB) Sample Questions (Q56-Q61):

NEW QUESTION # 56
When is an Advance Beneficiary Notice (ABN) required?

A. When a service is expected to be denied as not medically necessary
B. Only for inpatient services
C. For all Medicare services
D. After the service is denied

Answer: A

Explanation:
An ABN informs Medicare patients that they may be financially responsible if coverage is denied.

NEW QUESTION # 57
abdomin

A. extremities, top
B. toward
C. abdomen

Answer: C

NEW QUESTION # 58
Which document is mailed by the payer to the patient to illustrate the reimbrsement amount of a covered benefit?

A. Centers of Medicare and Medicaid Services150 (CMS1500)
B. Hold Harmless Clause
C. Health Insurance Claim
D. Explanation of Benefits

Answer: D

NEW QUESTION # 59
What is All Patient Refined DiagnosisRelated Group (ARPDRG)?

A. DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to nonMedicare beneficiaries (e.g. Blue Cross BlueShield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources.
B. Adopted by Medicare in 2008 to reimburse hospitals for inpatient care provided to Medicare beneficiaries; expanded original DRG system (based on intensity of resources) to add two subclasses to each DRG that adjusts Medicare inpatient hospital reimbursement rates for severity of illness (SOI) (extent of physiological decompensation or organ system loss of function) and risk of mortality (ROM) (likelihood of dying); each subclass, in turn, is subdivided into four areas: (1) minor, (2) moderate, (3) major, (4) extreme.

Answer: B

NEW QUESTION # 60
What is the primary purpose of National Correct Coding Initiative (NCCI) edits?

A. Identify unbundling and improper coding
B. Set reimbursement rates
C. Replace CPT guidelines
D. Increase claim approvals

Answer: A

Explanation:
NCCI edits prevent unbundling and inappropriate coding combinations.

NEW QUESTION # 61
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