AAPC CPB PRACTICE EXAM
QUESTIONS AND ANSWERS
Joe and Mary are a married couple and both carry insurance from their employers. Joe was b
km km km km km km km km km km km km km km km km
orn on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who c
km km km km km km km km km km km km km km km km km km
arries the primary insurance for their children for billing?
km km km km km km km km
A. Joe, because he is the male head of the household.
km km km km km km km km km km
B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd.
km km km km km km km km km km km km km km km km km
C. Mary, because her birth year is before Joe's birth year.
km km km km km km km km km km
D. Joe, because his birth month and day are before Mary's birth month and day. - ans-
km km km km km km km km km km km km km km km km
D. Joe, because his birth month and day are before Mary's birth month and day.
km km km km km km km km km km km km km km
Which type of managed care insurance allows patients to self-refer to out-of-
km km km km km km km km km km km
network providers and pay a higher co-insurance/copay amount?
km km km km km km km
I. HMO
km
II. PPO
km
III. EPO km
IV. POS km
V. Capitation
km
A. II km
B. IV km
C. II and IV
km km km
D. II, III, and V - ans-C. II and IV
km km km km km km km km km
A patient covered by a PPO is scheduled for knee replacement surgery. The biller contacts th
km km km km km km km km km km km km km km km
e insurance carrier to verify benefits and preauthorize the procedure. The carrier verifies the
km km km km km km km km km km km km km km
patient has a $500 deductible which must be met. After the deductible, the PPO will pay 80%
km km km km km km km km km km km km km km km km km
of the claim. The contracted rate for the procedure is $2,500. What is the patient's responsibili
km km km km km km km km km km km km km km km
ty?
A. $400km
B. $500km
C. $900km
D. $1,600 - ans-C. $900
km km km km
When a nonparticipating provider files a claim for a patient to BC/
km km km km km km km km km km km
BS, how is the payment processed?
km km km km km
A. The payment is sent to the patient and the patient must pay the provider.
km km km km km km km km km km km km km km
B. The payment is sent to the provider if the provider agrees to accept assignment.
km km km km km km km km km km km km km km
C. The payment is sent to the provider regardless if he accepts assignment.
km km km km km km km km km km km km
D. The claim is not paid because the provider is not participating in the plan. - ans-
km km km km km km km km km km km km km km km km
A. The payment is sent to the patient and the patient must pay the provider.
km km km km km km km km km km km km km km
Which of the following TRICARE options is/are available to active duty service members?
km km km km km km km km km km km km
,A. TRICARE Select
km km
B. TRICARE Prime
km km
C. TRICARE For Life
km km km
D. TRICARE Young Adult - ans-B. TRICARE Prime
km km km km km km km
A Medicare card will list which of the following:
km km km km km km km km
I. Effective date of coverage
km km km km
II. Home address
km km
III. Telephone Number
km km
IV. Entitled to Part A and/or Part B
km km km km km km km
V. When coverage ends
km km km
VI. Name of Primary Care Physician
km km km km km
A. I - VI
km km km
B. I, IV
km km
C. I-III, VI
km km
D. I, II, IV, V - ans-B. I, IV
km km km km km km km km
In which of the following scenarios is Medicare the secondary payer?
km km km km km km km km km km
I. A 65 year-
km km km
old patient who is collecting her deceased spouse's Medicare benefits and has a supplement
km km km km km km km km km km km km km
al insurance
km
II. A 72 year-old patient who participates in the group health insurance of his employer
km km km km km km km km km km km km km km
III. A 66 year-
km km km
old patient is injured at work and the employer does not offer health insurance as a benefit of
km km km km km km km km km km km km km km km km km km
employment
IV. A 55 year- km km km
old patient who is on disability through Social Security and qualifies for Medicaid and Medicar
km km km km km km km km km km km km km km
e
A. I-IVkm
B. II and III
km km km
C. I and IVkm km km
D. None - ans-B. II and III
km km km km km km
When a patient has Medicare primary and AARP as Medigap, what is entered on the CMS-
km km km km km km km km km km km km km km km
1500 claim form in item 9d for the Insurance Plan Name or Program Name for Medicare to cr
km km km km km km km km km km km km km km km km km
oss over the claim? km km km
A. Plan name followed by "MEDIGAP"
km km km km km
B. Plan Payer ID followed by "MEDIGAP"
km km km km km km
C. COBA Medigap claim-based identifier (ID)
km km km km km
D. Leave blank - ans-C. COBA Medigap claim-based identifier (ID)
km km km km km km km km km
Which guidelines must all billing personnel be knowledgeable about in order to ensure compli
km km km km km km km km km km km km km
ance with Medicaid programs? km km km
A. Federal guidelines
km km
B. State guidelines
km km
C. Both A and B
km km km km
D. None - ans-C. Both A and B
km km km km km km km
,Which of the following services is covered by Early and Periodic Screening, Diagnostic, and T
km km km km km km km km km km km km km km
reatment (EPSDT)? km
A. Family planning
km km
B. Obstetric care
km km
C. Pediatric checkups
km km
D. Emergency department visits - ans-C. Pediatric checkups
km km km km km km km
A female patient who was involved in an auto accident presents to the emergency departmen
km km km km km km km km km km km km km km
t (ED) for evaluation. She does not have any complaints. The provider evaluates her and dete
km km km km km km km km km km km km km km km
rmines there are no injuries. The provider informs the patient to come back to the ED or see h
km km km km km km km km km km km km km km km km km km
er primary care physician if she develops any symptoms. How is the claim processed for this
km km km km km km km km km km km km km km km km
encounter?
A. The medical insurance is billed primary and the auto insurance is billed secondary.
km km km km km km km km km km km km km
B. The auto insurance is billed primary and the medical insurance is billed secondary.
km km km km km km km km km km km km km
C. Bill the medical insurance first to receive a denial and then submit with the remittance advi
km km km km km km km km km km km km km km km km
ce to the auto insurance.
km km km km
D. Bill only the medical insurance because the auto insurance only covers damage to the vehi
km km km km km km km km km km km km km km km
cle, not medical expenses. - ans-
km km km km km
B. The auto insurance is billed primary and the medical insurance is billed secondary.
km km km km km km km km km km km km km
What forms need to be submitted when billing for a work-related injury?
km km km km km km km km km km km
A. Progress reports, and WC-1500 claim form
km km km km km km
B. UB-04 km
C. First Report of Injury form and an itemized statement
km km km km km km km km km
D. First Report of Injury form, progress reports, and CMS-1500 claim form - ans-
km km km km km km km km km km km km km
D. First Report of Injury form, progress reports, and CMS-1500 claim form
km km km km km km km km km km km
A document provided to Medicare patients explaining their financial responsibility if Medicare
km km km km km km km km km km km km
denies a service is a(n): km km km km
A. Notice of Financial Liability
km km km km
B. Advance Beneficiary Notice
km km km
C. Insurance waiver
km km
D. Explanation of Benefits - ans-B. Advance Beneficiary Notice
km km km km km km km km
What is an Accountable Care Organization (ACO)?
km km km km km km
A. Groups of doctors, hospitals, and other health care providers who coordinate high quality c
km km km km km km km km km km km km km km
are to Medicare patients.
km km km
B. An insurance carrier that provides a set fee based on the diagnosis of the patient.
km km km km km km km km km km km km km km km
C. A group of providers who contract with a third party administrator to pay fee for service for
km km km km km km km km km km km km km km km km km km
services.
D. Hospitals who see a subset of patients for cost efficiency. - ans-
km km km km km km km km km km km km
A. Groups of doctors, hospitals, and other health care providers who coordinate high quality c
km km km km km km km km km km km km km km
are to Medicare patients.
km km km
A new patient presents for her annual exam and has no complaints. She is scheduled to see t
km km km km km km km km km km km km km km km km km
he physician assistant (PA). How should services be billed ?
km km km km km km km km km
A. Bill under the PA.
km km km km
B. A new patient can be billed incident to the physician.
km km km km km km km km km km
, C. The PA cannot see new patients.
km km km km km km
D. Reschedule the patient with the physician - ans-A. Bill under the PA.
km km km km km km km km km km km km
CPT® codes 12032 and 12001 were reported together for a 2.6 cm intermediate repair of a la
km km km km km km km km km km km km km km km km
ceration to the right arm and a 2.5 cm simple repair of a laceration to the left arm. 12001 was
km km km km km km km km km km km km km km km km km km km km
denied as a bundled service. What action should be taken by the biller (following the CPT® g
km km km km km km km km km km km km km km km km
uidelines)?
A. Write-off the charge for 12001 as it is a bundled procedure.
km km km km km km km km km km km
B. Resubmit a corrected claim as 12032, 12001-59.
km km km km km km km
C. Transfer the charge to patient responsibility.
km km km km km km
D. Resubmit a corrected claim as 12032, 12001-51. - ans-
km km km km km km km km km
B. Resubmit a corrected claim as 12032, 12001-59.
km km km km km km km
According to CMS, which of the following services are included in the global package for surgi
km km km km km km km km km km km km km km km
cal procedures?
km
I. Surgical procedure performed
km km km
II. E/M visits unrelated to the diagnosis for which the surgical procedure is performed
km km km km km km km km km km km km km
III. Local infiltration, digital block, or topical anesthesia
km km km km km km km
IV. Treatment for postoperative complication which requires a return trip to the operating roo
km km km km km km km km km km km km km
m (OR)V. Writing Orders
km km km
VI. Postoperative infection treated in the office
km km km km km km
A. I, III, V, VI
km km km km
B. I, IV, V
km km km
C. I, II, III, V
km km km km
D. I-VI - ans-A. I, III, V, VI
km km km km km km km
Which CPT® code below can be reported with modifier 51?
km km km km km km km km km
A. 17004
km
B. 17312
km
C. 19101
km
D. 19126 - ans-C. 19101
km km km km
A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate?
km km km km km km km km km km km km km
A. Code pairs cannot be reported together.
km km km km km km
B. Codes can be reported together if documented. Append modifier 59.
km km km km km km km km km km
C. The code can only be reported for one unit of service on a single date of service.
km km km km km km km km km km km km km km km km km
D. Medically unlikely the code pair is performed together. - ans-
km km km km km km km km km km
C. The code can only be reported for one unit of service on a single date of service.
km km km km km km km km km km km km km km km km km
Electronic Healthcare Transactions and code sets are required to be used by health plans, he
km km km km km km km km km km km km km km
althcare clearinghouses and healthcare providers that participate in electronic data interchan
km km km km km km km km km km
ges. Which of the following are requirements for the code sets?
km km km km km km km km km km
I. Dental services are reported with CDT codes
km km km km km km km
II. Inpatient procedures are reported with HCPCS Level II codes
km km km km km km km km km
III. Diagnosis codes are reported with ICD-10-CM and ICD-10-PCS codes
km km km km km km km km km
IV. Outpatient services are reported with CPT® and HCPCS Level II codes
km km km km km km km km km km km
V. Physician services are reported with ICD-10-PCS codes
km km km km km km km
QUESTIONS AND ANSWERS
Joe and Mary are a married couple and both carry insurance from their employers. Joe was b
km km km km km km km km km km km km km km km km
orn on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who c
km km km km km km km km km km km km km km km km km km
arries the primary insurance for their children for billing?
km km km km km km km km
A. Joe, because he is the male head of the household.
km km km km km km km km km km
B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd.
km km km km km km km km km km km km km km km km km
C. Mary, because her birth year is before Joe's birth year.
km km km km km km km km km km
D. Joe, because his birth month and day are before Mary's birth month and day. - ans-
km km km km km km km km km km km km km km km km
D. Joe, because his birth month and day are before Mary's birth month and day.
km km km km km km km km km km km km km km
Which type of managed care insurance allows patients to self-refer to out-of-
km km km km km km km km km km km
network providers and pay a higher co-insurance/copay amount?
km km km km km km km
I. HMO
km
II. PPO
km
III. EPO km
IV. POS km
V. Capitation
km
A. II km
B. IV km
C. II and IV
km km km
D. II, III, and V - ans-C. II and IV
km km km km km km km km km
A patient covered by a PPO is scheduled for knee replacement surgery. The biller contacts th
km km km km km km km km km km km km km km km
e insurance carrier to verify benefits and preauthorize the procedure. The carrier verifies the
km km km km km km km km km km km km km km
patient has a $500 deductible which must be met. After the deductible, the PPO will pay 80%
km km km km km km km km km km km km km km km km km
of the claim. The contracted rate for the procedure is $2,500. What is the patient's responsibili
km km km km km km km km km km km km km km km
ty?
A. $400km
B. $500km
C. $900km
D. $1,600 - ans-C. $900
km km km km
When a nonparticipating provider files a claim for a patient to BC/
km km km km km km km km km km km
BS, how is the payment processed?
km km km km km
A. The payment is sent to the patient and the patient must pay the provider.
km km km km km km km km km km km km km km
B. The payment is sent to the provider if the provider agrees to accept assignment.
km km km km km km km km km km km km km km
C. The payment is sent to the provider regardless if he accepts assignment.
km km km km km km km km km km km km
D. The claim is not paid because the provider is not participating in the plan. - ans-
km km km km km km km km km km km km km km km km
A. The payment is sent to the patient and the patient must pay the provider.
km km km km km km km km km km km km km km
Which of the following TRICARE options is/are available to active duty service members?
km km km km km km km km km km km km
,A. TRICARE Select
km km
B. TRICARE Prime
km km
C. TRICARE For Life
km km km
D. TRICARE Young Adult - ans-B. TRICARE Prime
km km km km km km km
A Medicare card will list which of the following:
km km km km km km km km
I. Effective date of coverage
km km km km
II. Home address
km km
III. Telephone Number
km km
IV. Entitled to Part A and/or Part B
km km km km km km km
V. When coverage ends
km km km
VI. Name of Primary Care Physician
km km km km km
A. I - VI
km km km
B. I, IV
km km
C. I-III, VI
km km
D. I, II, IV, V - ans-B. I, IV
km km km km km km km km
In which of the following scenarios is Medicare the secondary payer?
km km km km km km km km km km
I. A 65 year-
km km km
old patient who is collecting her deceased spouse's Medicare benefits and has a supplement
km km km km km km km km km km km km km
al insurance
km
II. A 72 year-old patient who participates in the group health insurance of his employer
km km km km km km km km km km km km km km
III. A 66 year-
km km km
old patient is injured at work and the employer does not offer health insurance as a benefit of
km km km km km km km km km km km km km km km km km km
employment
IV. A 55 year- km km km
old patient who is on disability through Social Security and qualifies for Medicaid and Medicar
km km km km km km km km km km km km km km
e
A. I-IVkm
B. II and III
km km km
C. I and IVkm km km
D. None - ans-B. II and III
km km km km km km
When a patient has Medicare primary and AARP as Medigap, what is entered on the CMS-
km km km km km km km km km km km km km km km
1500 claim form in item 9d for the Insurance Plan Name or Program Name for Medicare to cr
km km km km km km km km km km km km km km km km km
oss over the claim? km km km
A. Plan name followed by "MEDIGAP"
km km km km km
B. Plan Payer ID followed by "MEDIGAP"
km km km km km km
C. COBA Medigap claim-based identifier (ID)
km km km km km
D. Leave blank - ans-C. COBA Medigap claim-based identifier (ID)
km km km km km km km km km
Which guidelines must all billing personnel be knowledgeable about in order to ensure compli
km km km km km km km km km km km km km
ance with Medicaid programs? km km km
A. Federal guidelines
km km
B. State guidelines
km km
C. Both A and B
km km km km
D. None - ans-C. Both A and B
km km km km km km km
,Which of the following services is covered by Early and Periodic Screening, Diagnostic, and T
km km km km km km km km km km km km km km
reatment (EPSDT)? km
A. Family planning
km km
B. Obstetric care
km km
C. Pediatric checkups
km km
D. Emergency department visits - ans-C. Pediatric checkups
km km km km km km km
A female patient who was involved in an auto accident presents to the emergency departmen
km km km km km km km km km km km km km km
t (ED) for evaluation. She does not have any complaints. The provider evaluates her and dete
km km km km km km km km km km km km km km km
rmines there are no injuries. The provider informs the patient to come back to the ED or see h
km km km km km km km km km km km km km km km km km km
er primary care physician if she develops any symptoms. How is the claim processed for this
km km km km km km km km km km km km km km km km
encounter?
A. The medical insurance is billed primary and the auto insurance is billed secondary.
km km km km km km km km km km km km km
B. The auto insurance is billed primary and the medical insurance is billed secondary.
km km km km km km km km km km km km km
C. Bill the medical insurance first to receive a denial and then submit with the remittance advi
km km km km km km km km km km km km km km km km
ce to the auto insurance.
km km km km
D. Bill only the medical insurance because the auto insurance only covers damage to the vehi
km km km km km km km km km km km km km km km
cle, not medical expenses. - ans-
km km km km km
B. The auto insurance is billed primary and the medical insurance is billed secondary.
km km km km km km km km km km km km km
What forms need to be submitted when billing for a work-related injury?
km km km km km km km km km km km
A. Progress reports, and WC-1500 claim form
km km km km km km
B. UB-04 km
C. First Report of Injury form and an itemized statement
km km km km km km km km km
D. First Report of Injury form, progress reports, and CMS-1500 claim form - ans-
km km km km km km km km km km km km km
D. First Report of Injury form, progress reports, and CMS-1500 claim form
km km km km km km km km km km km
A document provided to Medicare patients explaining their financial responsibility if Medicare
km km km km km km km km km km km km
denies a service is a(n): km km km km
A. Notice of Financial Liability
km km km km
B. Advance Beneficiary Notice
km km km
C. Insurance waiver
km km
D. Explanation of Benefits - ans-B. Advance Beneficiary Notice
km km km km km km km km
What is an Accountable Care Organization (ACO)?
km km km km km km
A. Groups of doctors, hospitals, and other health care providers who coordinate high quality c
km km km km km km km km km km km km km km
are to Medicare patients.
km km km
B. An insurance carrier that provides a set fee based on the diagnosis of the patient.
km km km km km km km km km km km km km km km
C. A group of providers who contract with a third party administrator to pay fee for service for
km km km km km km km km km km km km km km km km km km
services.
D. Hospitals who see a subset of patients for cost efficiency. - ans-
km km km km km km km km km km km km
A. Groups of doctors, hospitals, and other health care providers who coordinate high quality c
km km km km km km km km km km km km km km
are to Medicare patients.
km km km
A new patient presents for her annual exam and has no complaints. She is scheduled to see t
km km km km km km km km km km km km km km km km km
he physician assistant (PA). How should services be billed ?
km km km km km km km km km
A. Bill under the PA.
km km km km
B. A new patient can be billed incident to the physician.
km km km km km km km km km km
, C. The PA cannot see new patients.
km km km km km km
D. Reschedule the patient with the physician - ans-A. Bill under the PA.
km km km km km km km km km km km km
CPT® codes 12032 and 12001 were reported together for a 2.6 cm intermediate repair of a la
km km km km km km km km km km km km km km km km
ceration to the right arm and a 2.5 cm simple repair of a laceration to the left arm. 12001 was
km km km km km km km km km km km km km km km km km km km km
denied as a bundled service. What action should be taken by the biller (following the CPT® g
km km km km km km km km km km km km km km km km
uidelines)?
A. Write-off the charge for 12001 as it is a bundled procedure.
km km km km km km km km km km km
B. Resubmit a corrected claim as 12032, 12001-59.
km km km km km km km
C. Transfer the charge to patient responsibility.
km km km km km km
D. Resubmit a corrected claim as 12032, 12001-51. - ans-
km km km km km km km km km
B. Resubmit a corrected claim as 12032, 12001-59.
km km km km km km km
According to CMS, which of the following services are included in the global package for surgi
km km km km km km km km km km km km km km km
cal procedures?
km
I. Surgical procedure performed
km km km
II. E/M visits unrelated to the diagnosis for which the surgical procedure is performed
km km km km km km km km km km km km km
III. Local infiltration, digital block, or topical anesthesia
km km km km km km km
IV. Treatment for postoperative complication which requires a return trip to the operating roo
km km km km km km km km km km km km km
m (OR)V. Writing Orders
km km km
VI. Postoperative infection treated in the office
km km km km km km
A. I, III, V, VI
km km km km
B. I, IV, V
km km km
C. I, II, III, V
km km km km
D. I-VI - ans-A. I, III, V, VI
km km km km km km km
Which CPT® code below can be reported with modifier 51?
km km km km km km km km km
A. 17004
km
B. 17312
km
C. 19101
km
D. 19126 - ans-C. 19101
km km km km
A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate?
km km km km km km km km km km km km km
A. Code pairs cannot be reported together.
km km km km km km
B. Codes can be reported together if documented. Append modifier 59.
km km km km km km km km km km
C. The code can only be reported for one unit of service on a single date of service.
km km km km km km km km km km km km km km km km km
D. Medically unlikely the code pair is performed together. - ans-
km km km km km km km km km km
C. The code can only be reported for one unit of service on a single date of service.
km km km km km km km km km km km km km km km km km
Electronic Healthcare Transactions and code sets are required to be used by health plans, he
km km km km km km km km km km km km km km
althcare clearinghouses and healthcare providers that participate in electronic data interchan
km km km km km km km km km km
ges. Which of the following are requirements for the code sets?
km km km km km km km km km km
I. Dental services are reported with CDT codes
km km km km km km km
II. Inpatient procedures are reported with HCPCS Level II codes
km km km km km km km km km
III. Diagnosis codes are reported with ICD-10-CM and ICD-10-PCS codes
km km km km km km km km km
IV. Outpatient services are reported with CPT® and HCPCS Level II codes
km km km km km km km km km km km
V. Physician services are reported with ICD-10-PCS codes
km km km km km km km
