AAPC CPB FINAL EXAM QUESTIONS WITH COMPLETE
SOLUTIONS GUARANTEED PASS 2025/2026
A group contracts with a third-party administrator to manage paperwork. This
group pays for the operation of the insurance plan and the costs of
administration. What type of plan does this represent?
a. Association Group
b. Management Service Organization
c. Self-Funded ERISA
d. Fully Insured Employer Group
c. Self-Funded ERISA
A patient presents for an immunization. When the patient pays his bill, he asks
for a receipt so that he may turn it in to meet his spenddown.
What type of coverage does this patient have?
a. Commercial insurance
b. Medicare
c. Medicaid
d. TRICARE
c. Medicaid
What is an insurance plan that provides a gatekeeper to manage the patient's
healthcare?
,a. HMO
b. IPO
c. PPO
d. Medicaid
a. HMO
A patient presenting for care does not have an insurance card and is billed CPT®
code 99213 for $100. The patient pays $100 to the provider. A week later, the
patient presents verification of coverage through Medicaid for this date of
service. What process should be followed?
a. Nothing needs to be done
b. File a claim to Medicaid and refund the $100 to the patient
c. File a claim with Medicaid, a refund will be completed when the
EOB is received showing the patients responsibility
d. None of the above
c. File a claim with Medicaid, a refund will be completed when the EOB is received
showing the patients responsibility
Which of the following is NOT evaluated in the credentialing process?
a. Physician's residency
b. Physician's request for privileges
c. Physician's license(s)
,d. Physician's education
b. Physician's request for privileges
Review the insurance card and patient registration form below:
What information could cause a potential problem?
a. Employer is not listed
b. Date of birth is incorrect
c. The patient's name is not consistent
d. Relationship to the patient is incorrect
c. The patient's name is not consistent
Which of the following is NOT considered a part of the authorized process when
the patient signs the consent for payment?
a. Accept responsibility for any balance that is not covered by the patient's
insurance
b. Authorize payment to the provider
c. Authorize submission of a claim to insurance company
d. Authorization for treatment
d. Authorization for treatment
A patient presents to the ER but is admitted as an inpatient for care. What
copay is collected based on the insurance card for a participating facility?
, a. Not Applicable
b. $15.00
c.$100.00
d. $75.00
c.$100.00
A patient calls the PCP office after hours and is told to go to the ER.
What copay would be applicable to the ER visit?
a. $25.00
b. $50.00
c. $35.00
d. $100.00
d. $100.00
Which of the following is true when entering patient data information into a
PMS?
a. The format of the information is not important but must be entered
b. Enter the patient information accurately from the insurance card and patient
registration form
c. Assume the information is correct
d. Review the information annually for correctness
SOLUTIONS GUARANTEED PASS 2025/2026
A group contracts with a third-party administrator to manage paperwork. This
group pays for the operation of the insurance plan and the costs of
administration. What type of plan does this represent?
a. Association Group
b. Management Service Organization
c. Self-Funded ERISA
d. Fully Insured Employer Group
c. Self-Funded ERISA
A patient presents for an immunization. When the patient pays his bill, he asks
for a receipt so that he may turn it in to meet his spenddown.
What type of coverage does this patient have?
a. Commercial insurance
b. Medicare
c. Medicaid
d. TRICARE
c. Medicaid
What is an insurance plan that provides a gatekeeper to manage the patient's
healthcare?
,a. HMO
b. IPO
c. PPO
d. Medicaid
a. HMO
A patient presenting for care does not have an insurance card and is billed CPT®
code 99213 for $100. The patient pays $100 to the provider. A week later, the
patient presents verification of coverage through Medicaid for this date of
service. What process should be followed?
a. Nothing needs to be done
b. File a claim to Medicaid and refund the $100 to the patient
c. File a claim with Medicaid, a refund will be completed when the
EOB is received showing the patients responsibility
d. None of the above
c. File a claim with Medicaid, a refund will be completed when the EOB is received
showing the patients responsibility
Which of the following is NOT evaluated in the credentialing process?
a. Physician's residency
b. Physician's request for privileges
c. Physician's license(s)
,d. Physician's education
b. Physician's request for privileges
Review the insurance card and patient registration form below:
What information could cause a potential problem?
a. Employer is not listed
b. Date of birth is incorrect
c. The patient's name is not consistent
d. Relationship to the patient is incorrect
c. The patient's name is not consistent
Which of the following is NOT considered a part of the authorized process when
the patient signs the consent for payment?
a. Accept responsibility for any balance that is not covered by the patient's
insurance
b. Authorize payment to the provider
c. Authorize submission of a claim to insurance company
d. Authorization for treatment
d. Authorization for treatment
A patient presents to the ER but is admitted as an inpatient for care. What
copay is collected based on the insurance card for a participating facility?
, a. Not Applicable
b. $15.00
c.$100.00
d. $75.00
c.$100.00
A patient calls the PCP office after hours and is told to go to the ER.
What copay would be applicable to the ER visit?
a. $25.00
b. $50.00
c. $35.00
d. $100.00
d. $100.00
Which of the following is true when entering patient data information into a
PMS?
a. The format of the information is not important but must be entered
b. Enter the patient information accurately from the insurance card and patient
registration form
c. Assume the information is correct
d. Review the information annually for correctness
