CPB CERTIFICATION STUDY SHEET 2026
ACCURATE QUESTIONS AND VERIFIED
SOLUTIONS A+
● PATIENT IS BROUGHT TO THE LOCAL URGENT CARE AFTER
FALLING FROM A LADDER WHILE HANGING EXTERIOR
LIGHTS ON HIS HOUSE. X-RAYS REVEALED A CLOSED
FRACTURE OF HIS LEFT FEMUR. THE PATIENT IS COVERED
BY HIS EMPLOYER'S GROUP HEALTH PLAN AND HE ALSO HAS
A HOMEOWNER'S LIABILITY INSURANCE POLICY. WHICH
INSURANCE SHOULD BE BILLED?
A) THE HOMEOWNER'S INSURANCE FIRST, FOLLOWED BY
THE GROUP HEALTH PLAN
B) THE EMPLOYER'S GROUP HEALTH PLAN
C) THE HOMEOWNER'S INSURANCE ONLY
D) FILE THE EMPLOYER'S GROUP HEALTH PLAN AS PRIMARY
AND LIST THE HOMEOWNER'S INSURANCE AS SECONDARY..
Answer: B) THE EMPLOYER'S GROUP HEALTH PLAN
RATIONALE: THE HEALTH INSURANCE PLAN IS BILLED FIRST
AND THEN THROUGH THE PROCESS OF SUBROGATION IT
WILL BE DETERMINED IF A LIABILITY PAYER SHOULD BE
CONSIDERED PRIMARY.
,● 3. PRIVATE COMPANIES CONTRACT WITH CMS TO
ADMINISTER:
A) MEDICARE PART A & B
B) MEDICARE PART B
C) MEDICARE PART C
D) MEDICARE PART A, B, & C. Answer: D) MEDICARE PART A, B,
AND C
RATIONALE: MEDICARE PART A, B, AND C ARE ALL
ADMINISTERED BY PRIVATE COMPANIES THAT CONTRACT
WITH CMS AS MEDICARE ADMINISTRATIVE CONTRACTORS
OR MACs.
● WHAT IS A CO-PAYMENT?
A) AN AMOUNT PAID EVERY MONTH BY THE POLICYHOLDER
TO MAINTAIN HEALTH INSURANCE COVERAGE
B) A PERCENTAGE OF THE ALLOWED AMOUNT THAT THE
PATIENT IS RESPONSIBLE FOR.
C) A FLAT AMOUNT PAID TO THE HEALTHCARE PROVIDER
WHEN THE POLICYHOLDER IS SEEN FOR AN OFFICE VISIT.
D) THE ADJUSTED AMOUNT BASED ON THE INSURANCE
POLICY REQUIREMENT.. Answer: C) A FLAT AMOUNT PAID TO
,THE HEALTHCARE PROVIDER WHEN THE POLICY HOLDER IS
SEEN FOR AN OFFICE VISIT.
● WHICH OF THE FOLLOWING STATEMENTS IS TRUE
REGARDING THE NON-PAR MEDICARE ALLOWED FEE
SCHEDULE?
A) THE NON-PAR PROVIDER CAN BILL THE PATIENT THE
DIFFERENCE BETWEEN THE CHARGE AND THE MEDICARE
ALLOWABLE.
B) THE NON-PAR LIMITING CHARGE IS 115% OF THE NON-PAR
MEDICARE PHYSICIAN FEE SCHEDULE
C) THE NON-PAR PHYSICIAN FEE SCHEDULE IS 115% OF THE
PAR MEDICARE PHYSICIAN FEE SCHEDULE
D) THE NON-PAR LIMITING CHARGE IS 95% OF THE PAR
MEDICARE PHYSICIAN FEE SCHEDULE.. Answer: B) THE NON-
PAR LIMITING CHARGE IS 115% OF THE NON-PAR MEDICARE
PHYSICIAN FEE SCHEDULE.
RATIONALE: PER CMS, THE NON-PAR LIMITING CHARGE IS
115% OF THE NON-PAR MEDICARE PHYSICIAN FEE
SCHEDULE.
● WHAT IS A MEDIGAP POLICY?
, A) A POLICY THAT COVERS HEALTHCARE SERVICES THAT
MEDICARE DOES NOT COVER.
B) A POLICY THAT WILL NOT REIMBURSE FOR OUT-OF-
POCKET COSTS NOT COVERED BY MEDICARE
C) A SUPPLEMENTAL INSURANCE OFFERED BY CMS.
D) A POLICY REQUIRED BY MEDICARE.. Answer: A) A POLICY
THAT COVERS HEALTHCARE SERVICES THAT MEDICARE
DOES NOT COVER.
● MEDICARE PART A IS AVAILABLE TO INDIVIDUALS UNDER
THE AGE OF 65 WHO HAVE:
A) DIABETES MELLITUS TYPE I OR II
B) CKD (CHRONIC KIDNEY DISEASE)
C) ESRD AND MEET CERTAIN REQUIREMENTS
D) ANY CHRONIC HEALTH CONDITION. Answer: C) ESRD AND
MEET CERTAIN REQUIREMENTS.
RATIONALE: MEDICARE PART A COVERAGE IS AVAILABLE TO
INDIVIDUALS BELOW THE AGE OF 65 WHO HAVE; 1)
RECEIVED SOCIAL SECURITY OR RRB DISABILITY BENEFITS
FOR 24 MONTHS, 2) END-STAGE RENAL DISEASE AND MEET
CERTAIN REQUIREMENTS
ACCURATE QUESTIONS AND VERIFIED
SOLUTIONS A+
● PATIENT IS BROUGHT TO THE LOCAL URGENT CARE AFTER
FALLING FROM A LADDER WHILE HANGING EXTERIOR
LIGHTS ON HIS HOUSE. X-RAYS REVEALED A CLOSED
FRACTURE OF HIS LEFT FEMUR. THE PATIENT IS COVERED
BY HIS EMPLOYER'S GROUP HEALTH PLAN AND HE ALSO HAS
A HOMEOWNER'S LIABILITY INSURANCE POLICY. WHICH
INSURANCE SHOULD BE BILLED?
A) THE HOMEOWNER'S INSURANCE FIRST, FOLLOWED BY
THE GROUP HEALTH PLAN
B) THE EMPLOYER'S GROUP HEALTH PLAN
C) THE HOMEOWNER'S INSURANCE ONLY
D) FILE THE EMPLOYER'S GROUP HEALTH PLAN AS PRIMARY
AND LIST THE HOMEOWNER'S INSURANCE AS SECONDARY..
Answer: B) THE EMPLOYER'S GROUP HEALTH PLAN
RATIONALE: THE HEALTH INSURANCE PLAN IS BILLED FIRST
AND THEN THROUGH THE PROCESS OF SUBROGATION IT
WILL BE DETERMINED IF A LIABILITY PAYER SHOULD BE
CONSIDERED PRIMARY.
,● 3. PRIVATE COMPANIES CONTRACT WITH CMS TO
ADMINISTER:
A) MEDICARE PART A & B
B) MEDICARE PART B
C) MEDICARE PART C
D) MEDICARE PART A, B, & C. Answer: D) MEDICARE PART A, B,
AND C
RATIONALE: MEDICARE PART A, B, AND C ARE ALL
ADMINISTERED BY PRIVATE COMPANIES THAT CONTRACT
WITH CMS AS MEDICARE ADMINISTRATIVE CONTRACTORS
OR MACs.
● WHAT IS A CO-PAYMENT?
A) AN AMOUNT PAID EVERY MONTH BY THE POLICYHOLDER
TO MAINTAIN HEALTH INSURANCE COVERAGE
B) A PERCENTAGE OF THE ALLOWED AMOUNT THAT THE
PATIENT IS RESPONSIBLE FOR.
C) A FLAT AMOUNT PAID TO THE HEALTHCARE PROVIDER
WHEN THE POLICYHOLDER IS SEEN FOR AN OFFICE VISIT.
D) THE ADJUSTED AMOUNT BASED ON THE INSURANCE
POLICY REQUIREMENT.. Answer: C) A FLAT AMOUNT PAID TO
,THE HEALTHCARE PROVIDER WHEN THE POLICY HOLDER IS
SEEN FOR AN OFFICE VISIT.
● WHICH OF THE FOLLOWING STATEMENTS IS TRUE
REGARDING THE NON-PAR MEDICARE ALLOWED FEE
SCHEDULE?
A) THE NON-PAR PROVIDER CAN BILL THE PATIENT THE
DIFFERENCE BETWEEN THE CHARGE AND THE MEDICARE
ALLOWABLE.
B) THE NON-PAR LIMITING CHARGE IS 115% OF THE NON-PAR
MEDICARE PHYSICIAN FEE SCHEDULE
C) THE NON-PAR PHYSICIAN FEE SCHEDULE IS 115% OF THE
PAR MEDICARE PHYSICIAN FEE SCHEDULE
D) THE NON-PAR LIMITING CHARGE IS 95% OF THE PAR
MEDICARE PHYSICIAN FEE SCHEDULE.. Answer: B) THE NON-
PAR LIMITING CHARGE IS 115% OF THE NON-PAR MEDICARE
PHYSICIAN FEE SCHEDULE.
RATIONALE: PER CMS, THE NON-PAR LIMITING CHARGE IS
115% OF THE NON-PAR MEDICARE PHYSICIAN FEE
SCHEDULE.
● WHAT IS A MEDIGAP POLICY?
, A) A POLICY THAT COVERS HEALTHCARE SERVICES THAT
MEDICARE DOES NOT COVER.
B) A POLICY THAT WILL NOT REIMBURSE FOR OUT-OF-
POCKET COSTS NOT COVERED BY MEDICARE
C) A SUPPLEMENTAL INSURANCE OFFERED BY CMS.
D) A POLICY REQUIRED BY MEDICARE.. Answer: A) A POLICY
THAT COVERS HEALTHCARE SERVICES THAT MEDICARE
DOES NOT COVER.
● MEDICARE PART A IS AVAILABLE TO INDIVIDUALS UNDER
THE AGE OF 65 WHO HAVE:
A) DIABETES MELLITUS TYPE I OR II
B) CKD (CHRONIC KIDNEY DISEASE)
C) ESRD AND MEET CERTAIN REQUIREMENTS
D) ANY CHRONIC HEALTH CONDITION. Answer: C) ESRD AND
MEET CERTAIN REQUIREMENTS.
RATIONALE: MEDICARE PART A COVERAGE IS AVAILABLE TO
INDIVIDUALS BELOW THE AGE OF 65 WHO HAVE; 1)
RECEIVED SOCIAL SECURITY OR RRB DISABILITY BENEFITS
FOR 24 MONTHS, 2) END-STAGE RENAL DISEASE AND MEET
CERTAIN REQUIREMENTS
