2026/2027 Exam Questions and
Correct Answers | New Update
Joe and Mary are a married couple and both carry insurance from their
employers. Joe was born on February 23, 1977 and Mary was born on
April 4, 1974. Using the birthday rule, who carries the primary insurance
for their children for billing?
A. Joe, because he is the male head of the household.
B. Mary, because her date of birth is the 4th and Joe's date of birth is the
23rd.
,C. Mary, because her birth year is before Joe's birth year.
D. Joe, because his birth month and day are before Mary's birth month
and day. - ANSWER ✔✔D. Joe, because his birth month and day are
before Mary's birth month and day.
Which type of managed care insurance allows patients to self-refer to
out-of-network providers and pay a higher co-insurance/copay amount?
I. HMO
II. PPO
III. EPO
IV. POS
V. Capitation
A. II
B. IV
C. II and IV
D. II, III, and V - ANSWER ✔✔C. II and IV
,A patient covered by a PPO is scheduled for knee replacement surgery.
The biller contacts the insurance carrier to verify benefits and
preauthorize the procedure. The carrier verifies the patient has a $500
deductible which must be met. After the deductible, the PPO will pay
80% of the claim. The contracted rate for the procedure is $2,500. What
is the patient's responsibility?
A. $400
B. $500
C. $900
D. $1,600 - ANSWER ✔✔C. $900
When a nonparticipating provider files a claim for a patient to BC/BS,
how is the payment processed?
A. The payment is sent to the patient and the patient must pay the
provider.
B. The payment is sent to the provider if the provider agrees to accept
assignment.
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, C. The payment is sent to the provider regardless if he accepts
assignment.
D. The claim is not paid because the provider is not participating in the
plan. - ANSWER ✔✔A. The payment is sent to the patient and the
patient must pay the provider.
Which of the following TRICARE options is/are available to active duty
service members?
A. TRICARE Select
B. TRICARE Prime
C. TRICARE For Life
D. TRICARE Young Adult - ANSWER ✔✔B. TRICARE Prime
A Medicare card will list which of the following:
I. Effective date of coverage
II. Home address
III. Telephone Number
IV. Entitled to Part A and/or Part B