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Free CBCS Practice Questions

10 free, exam-style Certified Billing and Coding Specialist (CBCS) practice questions with answers and explanations. No signup required. Work through them below, then take the full free CBCS practice test to study every exam domain.

Question 1

A child is covered under both parents' employer-sponsored health insurance plans. Parent A's date of birth is March 5, 1990. Parent B's date of birth is August 19, 1987. Using the Birthday Rule, which plan should be billed as the primary payer for the child?

  1. Parent A's plan, because March 5 falls earlier in the calendar year than August 19
  2. Parent B's plan, because Parent B is older and therefore holds the primary policy
  3. Parent B's plan, because 1987 comes before 1990, making Parent B's plan primary
  4. Parent A's plan, because the plan with the most comprehensive benefits is always primary
Show answer & explanation

Correct answer: A - Parent A's plan, because March 5 falls earlier in the calendar year than August 19

Question 2

A provider submits a claim with total charges of $350. The payer's allowed amount is $260, and the remittance advice posts a CO-45 adjustment of $90. The patient has satisfied their annual deductible and owes 20% coinsurance on the allowed amount. How much of the $90 CO-45 adjustment may the provider collect from the patient?

  1. $0 - CO-45 is a contractual write-off and cannot be billed to the patient
  2. $90, since the patient is responsible for any amount exceeding the payer's allowed rate
  3. $52, which represents 20% of the $260 allowed amount
  4. $90, provided the patient signed a financial responsibility agreement at registration
Show answer & explanation

Correct answer: A - $0 - CO-45 is a contractual write-off and cannot be billed to the patient

Question 3

A physician holds a 15% ownership stake in a freestanding physical therapy clinic. She regularly refers her Medicare patients to this clinic for post-surgical rehabilitation. No payments, bonuses, or gifts are exchanged between the physician and the clinic in connection with the referrals. Which federal law has MOST likely been violated?

  1. Anti-Kickback Statute, because the physician profits financially from the referrals
  2. No federal law, because no payment was exchanged in return for the referrals
  3. Stark Law, since a prohibited financial relationship and Medicare referral both exist
  4. False Claims Act, because Medicare was billed for services generated by the referral
Show answer & explanation

Correct answer: C - Stark Law, since a prohibited financial relationship and Medicare referral both exist

Question 4

A Medicare claim is returned from the clearinghouse with a message that the patient's subscriber ID does not match payer records. The claim has not entered the payer's adjudication system. The billing specialist should classify this claim as which of the following, and take what action?

  1. A denied claim; file a Level 1 Redetermination appeal with the MAC within 120 days
  2. A denied claim; issue a corrected claim using resubmission frequency code 7 in CMS-1500 Block 22
  3. A rejected claim; correct the subscriber ID and resubmit the claim as a new submission
  4. A rejected claim; document the error and write off the balance as an administrative loss
Show answer & explanation

Correct answer: C - A rejected claim; correct the subscriber ID and resubmit the claim as a new submission

Question 5

A physician practice routinely issues Advance Beneficiary Notices (ABNs) to Medicare patients before services that may not be covered. A patient arrives who is enrolled in a Medicare Advantage (Part C) plan. Should the practice issue an ABN to this patient?

  1. Yes - all Medicare beneficiaries, regardless of plan type, are entitled to receive an ABN
  2. No - ABNs apply only to Original Medicare (Parts A and B), not Medicare Advantage
  3. Yes - but only if the Medicare Advantage plan has already issued a pre-authorization denial
  4. No - ABNs are only required when a service is permanently excluded from all Medicare coverage
Show answer & explanation

Correct answer: B - No - ABNs apply only to Original Medicare (Parts A and B), not Medicare Advantage

Question 6

A coder is assigning diagnoses for a patient with Type 2 diabetes with diabetic chronic kidney disease (E11.65). The Tabular List shows an Excludes1 note under E11.65 for diabetic nephropathy (E11.21). The attending physician has documented both conditions in the same encounter. According to ICD-10-CM Official Guidelines, the coder should:

  1. Assign both codes, as both conditions are present and documented
  2. Assign only E11.21, since the Excludes1 note indicates it supersedes E11.65
  3. Query the physician; Excludes1 notes signal a potential documentation contradiction
  4. Assign only E11.65 and not E11.21 - Excludes1 means both codes cannot be used together
Show answer & explanation

Correct answer: D - Assign only E11.65 and not E11.21 - Excludes1 means both codes cannot be used together

Question 7

A provider submits a Medicare claim that is denied. After filing a written Redetermination request, the MAC reviews the claim and upholds the denial. The provider still believes the claim should be paid. What is the CORRECT next step in the Medicare appeals process?

  1. File a second Redetermination with the MAC, including additional supporting documentation
  2. Request Reconsideration by a Qualified Independent Contractor (QIC)
  3. Request an Administrative Law Judge (ALJ) hearing through OMHA
  4. File for Judicial Review in U.S. District Court
Show answer & explanation

Correct answer: B - Request Reconsideration by a Qualified Independent Contractor (QIC)

Question 8

A surgeon evaluates an established patient in the office and conducts a high-complexity E/M service. During the visit, she determines the patient requires a total hip replacement and schedules the surgery for the following week. The surgery carries a 90-day global period. Which modifier should be appended to the E/M service code billed for today's encounter?

  1. Modifier -57, because this E/M led to the decision to perform major surgery
  2. Modifier -25, because the E/M was a significant, separately identifiable service
  3. Modifier -24, because the E/M is unrelated to any current postoperative period
  4. No modifier - the E/M is automatically bundled into the global fee for the scheduled procedure
Show answer & explanation

Correct answer: A - Modifier -57, because this E/M led to the decision to perform major surgery

Question 9

A physician practice contracts with an external medical billing company to submit insurance claims on its behalf. The billing company requires access to patient health records and demographic data to perform this work. Under HIPAA, what must be in place before the billing company may access this protected health information?

  1. Written patient authorization for each individual whose records will be accessed by the billing company
  2. A Notice of Privacy Practices (NPP) signed and acknowledged by each affected patient
  3. A Business Associate Agreement (BAA) between the physician practice and the billing company
  4. No special agreement is required, because claim submission is a covered payment activity under HIPAA TPO
Show answer & explanation

Correct answer: C - A Business Associate Agreement (BAA) between the physician practice and the billing company

Question 10

A patient was treated in the emergency department three weeks ago for a closed fracture of the left distal radius. That encounter was coded with a seventh character 'A.' She returns today for a scheduled follow-up with her orthopedic surgeon; the fracture is actively healing and no new treatment intervention is performed. Which seventh character applies to the fracture code for today's encounter?

  1. A - this is the first time the patient is being seen by the orthopedic surgeon
  2. D - the patient is receiving routine care during the healing phase
  3. S - this is a sequela visit following the original traumatic injury
  4. No seventh character - outpatient follow-up visits do not require injury code extensions
Show answer & explanation

Correct answer: B - D - the patient is receiving routine care during the healing phase

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