CPB PRACTICE EXAMS SET 2026
COMPLETE QUESTIONS AND ANSWERS
CERTIFICATION EVALUATION EXAMS FULL
SOLUTION GRADED A+
⩥ While working in a large practice, medicare over-payments are found
in several patient accounts. The manager states that the practice will
keep the money until medicare asks for it back. What does this action
constitute? Answer: Fraud
⩥ What are the 12 national priority purposes under the privacy rule?
Answer: 1. Required by law
2. Public health activities
3. Victims of abuse / neglect/ domestic violence
4. Health oversight activities
5. Judicial and administrative proceedings
6. Law enforcement purposes
7. decedents
8. cadaver organ / eye / tissue donation
9. Research
10. Serious threat to health or safety
11. Essential government functions
,12. Workers comp
⩥ What types of entities do conditions of participation apply to for
health plans? Answer: Hospitals, clinics, transplant centers, psychiatric
hospitals, etc
⩥ What is the Prompt Payment Act? Answer: An act that was enacted to
ensure the federal government makes timely payments.
⩥ A provider removes a skin lesion in an ASC and receives the denial
from the insurance carrier that states "Lower level of care could have
been provided." What steps should the biller take? Answer: Check with
the provider and write an appeal to the insurance carrier explaining why
the service was provided in an ASC.
⩥ What is the definition of bad debt? Answer: A debt that is likely to
remain unpaid and end up sent to collections and written off by the
provider.
⩥ What are some potential patient errors that can happen at patient
registration? Answer: Invalid address, invalid insurance info, invalid
phone number
⩥ What is the number one thing you should obtain from an insurance
call? Answer: The call reference number
,⩥ When given a denial, what should be done? Answer: Review the
denial to determine if additional information is needed, if errors need to
be corrected, or if the denial should be appealed
⩥ May small balances for which processing costs exceed potential
collections be automatically written off? Answer: Yes, as long as it is
allowed according to the financial policy of the practice.
⩥ What a patient files for Chapter 7 under the U.S. bankruptcy code,
what happens to the debt? Answer: Most medical debt is discharged, the
provider will write-off amounts owed.
⩥ According to the Prompt Pay Act, who must pay bills within 30 days?
Answer: Federal Agencies
⩥ What is a pre-determination? Answer: A request from a healthcare
facility to get an idea whether or not a service may be covered. This is
not a guarantee of payment and is not required.
⩥ The provider, hospital, or entity that agrees to provide healthcare
services to an insurance plans enrolees is a: Answer: Participating
provider
, ⩥ Balance billing by participating providers is: Answer: Not allowed
under participating providers contract
⩥ If a claim is denied, investigated, or found to be denied in error what
should a biller do? Answer: Appeal that claim
⩥ What may be appealed? Answer: A denied claim
⩥ What modifiers will appropriately bypass the NCCI bundling edits?
Answer: 25, 58
⩥ What can be done in the practice to ensure liability denials will not be
received? Answer: Perform thorough intake on patients that present with
injuries
⩥ BCBS received a claim on 4/15/14 for services performed on 3/15/13
the claim would be denied because: Answer: The claim was filed after
the timely filing limit
⩥ What information can be found on an EOB (Explanation of Benefits)?
Answer: details medical services, provider charges, the insurance
company's allowed amount, the amount paid by the plan, and any
remaining balance for the patient to pay. It also includes the patient's and
provider's names, the service dates, and a summary of payments,
COMPLETE QUESTIONS AND ANSWERS
CERTIFICATION EVALUATION EXAMS FULL
SOLUTION GRADED A+
⩥ While working in a large practice, medicare over-payments are found
in several patient accounts. The manager states that the practice will
keep the money until medicare asks for it back. What does this action
constitute? Answer: Fraud
⩥ What are the 12 national priority purposes under the privacy rule?
Answer: 1. Required by law
2. Public health activities
3. Victims of abuse / neglect/ domestic violence
4. Health oversight activities
5. Judicial and administrative proceedings
6. Law enforcement purposes
7. decedents
8. cadaver organ / eye / tissue donation
9. Research
10. Serious threat to health or safety
11. Essential government functions
,12. Workers comp
⩥ What types of entities do conditions of participation apply to for
health plans? Answer: Hospitals, clinics, transplant centers, psychiatric
hospitals, etc
⩥ What is the Prompt Payment Act? Answer: An act that was enacted to
ensure the federal government makes timely payments.
⩥ A provider removes a skin lesion in an ASC and receives the denial
from the insurance carrier that states "Lower level of care could have
been provided." What steps should the biller take? Answer: Check with
the provider and write an appeal to the insurance carrier explaining why
the service was provided in an ASC.
⩥ What is the definition of bad debt? Answer: A debt that is likely to
remain unpaid and end up sent to collections and written off by the
provider.
⩥ What are some potential patient errors that can happen at patient
registration? Answer: Invalid address, invalid insurance info, invalid
phone number
⩥ What is the number one thing you should obtain from an insurance
call? Answer: The call reference number
,⩥ When given a denial, what should be done? Answer: Review the
denial to determine if additional information is needed, if errors need to
be corrected, or if the denial should be appealed
⩥ May small balances for which processing costs exceed potential
collections be automatically written off? Answer: Yes, as long as it is
allowed according to the financial policy of the practice.
⩥ What a patient files for Chapter 7 under the U.S. bankruptcy code,
what happens to the debt? Answer: Most medical debt is discharged, the
provider will write-off amounts owed.
⩥ According to the Prompt Pay Act, who must pay bills within 30 days?
Answer: Federal Agencies
⩥ What is a pre-determination? Answer: A request from a healthcare
facility to get an idea whether or not a service may be covered. This is
not a guarantee of payment and is not required.
⩥ The provider, hospital, or entity that agrees to provide healthcare
services to an insurance plans enrolees is a: Answer: Participating
provider
, ⩥ Balance billing by participating providers is: Answer: Not allowed
under participating providers contract
⩥ If a claim is denied, investigated, or found to be denied in error what
should a biller do? Answer: Appeal that claim
⩥ What may be appealed? Answer: A denied claim
⩥ What modifiers will appropriately bypass the NCCI bundling edits?
Answer: 25, 58
⩥ What can be done in the practice to ensure liability denials will not be
received? Answer: Perform thorough intake on patients that present with
injuries
⩥ BCBS received a claim on 4/15/14 for services performed on 3/15/13
the claim would be denied because: Answer: The claim was filed after
the timely filing limit
⩥ What information can be found on an EOB (Explanation of Benefits)?
Answer: details medical services, provider charges, the insurance
company's allowed amount, the amount paid by the plan, and any
remaining balance for the patient to pay. It also includes the patient's and
provider's names, the service dates, and a summary of payments,
