AAPC CPB 2027 TEST PAPER ANSWERS AND
QUESTIONS SET A+
✔✔A patient presenting for care does not have an insurance card and is billed CPT
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? - ✔✔file a claim to Medicaid w EOB
✔✔Medicare part without a monthly charge if worked for 10+ years - ✔✔A
✔✔Managed Care Organizations (MCOs) place the physician at financial risk for the
care of the patient and are reimbursed by - ✔✔capitation
✔✔Which of the following is NOT evaluated in the credentialing process? - ✔✔phys req
for priviledges
✔✔HSA is ____________________ to employees - ✔✔tax free income
✔✔What type of plan allows an insurer to administer straight indemnity insurance, an
HMO, or a PPO insurance plans to its members? - ✔✔triple option
✔✔A healthcare organization with 2 hospitals, 20 clinics, and 3 urgent care centers
belongs to an ACO program. They have been in the shared savings program for two
years and are now eligible to move large payments to a population-based model as they
have been successful in keeping costs down and have met all the CMS benchmarks set
for them. What type of ACO is this? - ✔✔Pioneer
✔✔What is the largest health program in the United States? - ✔✔Medicare
✔✔a unique 10-digit identification number required by HIPAA - ✔✔NPI
, ✔✔Medicaid plans provide for low-income families. Which statement regarding
Medicaid is NOT correct? - ✔✔All plans offer HMOs
✔✔A new physician comes in to the practice that is just out of medical school. He will
need to be able to see patients in the office and at the hospital. What process will he
need to undergo in order to be able to participate with Medicare and other health plans?
- ✔✔credentialling
✔✔NPI numbers have two types of entities - identify the two types: - ✔✔group and sole
proprietor
✔✔NPI - ✔✔National Provider Identifier
✔✔Which of the following services is NOT covered under Medicare Part B? - ✔✔Home
Health
✔✔ACOs are formed with ___ lives - ✔✔5000
✔✔HMOs are formed with ___ lives - ✔✔100,000 +
✔✔When insurance coverage is being verified, which of the following is NOT a method
on which to rely? - ✔✔patient
✔✔When a fee ticket (encounter form) is not completed, what procedure would NOT be
acceptable? - ✔✔no charge
✔✔Information about deductibles, copays, eligibility dates, and benefit plans is
completed during what step? - ✔✔verify benefits
✔✔determine primary and secondary coverage - ✔✔birthday rule
✔✔Which of the following is NOT considered a part of the authorized process when the
patient signs the consent for payment? - ✔✔auth for treatment
✔✔Patient types help to classify the patients based on - ✔✔payer, ins type
✔✔Life Cycle of a Claim - ✔✔submission
processing
adjudication
payment/denial
✔✔What authorizes information to be sent to the insurance payer so payment of
medical benefits can be processed? - ✔✔consent for payment
QUESTIONS SET A+
✔✔A patient presenting for care does not have an insurance card and is billed CPT
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? - ✔✔file a claim to Medicaid w EOB
✔✔Medicare part without a monthly charge if worked for 10+ years - ✔✔A
✔✔Managed Care Organizations (MCOs) place the physician at financial risk for the
care of the patient and are reimbursed by - ✔✔capitation
✔✔Which of the following is NOT evaluated in the credentialing process? - ✔✔phys req
for priviledges
✔✔HSA is ____________________ to employees - ✔✔tax free income
✔✔What type of plan allows an insurer to administer straight indemnity insurance, an
HMO, or a PPO insurance plans to its members? - ✔✔triple option
✔✔A healthcare organization with 2 hospitals, 20 clinics, and 3 urgent care centers
belongs to an ACO program. They have been in the shared savings program for two
years and are now eligible to move large payments to a population-based model as they
have been successful in keeping costs down and have met all the CMS benchmarks set
for them. What type of ACO is this? - ✔✔Pioneer
✔✔What is the largest health program in the United States? - ✔✔Medicare
✔✔a unique 10-digit identification number required by HIPAA - ✔✔NPI
, ✔✔Medicaid plans provide for low-income families. Which statement regarding
Medicaid is NOT correct? - ✔✔All plans offer HMOs
✔✔A new physician comes in to the practice that is just out of medical school. He will
need to be able to see patients in the office and at the hospital. What process will he
need to undergo in order to be able to participate with Medicare and other health plans?
- ✔✔credentialling
✔✔NPI numbers have two types of entities - identify the two types: - ✔✔group and sole
proprietor
✔✔NPI - ✔✔National Provider Identifier
✔✔Which of the following services is NOT covered under Medicare Part B? - ✔✔Home
Health
✔✔ACOs are formed with ___ lives - ✔✔5000
✔✔HMOs are formed with ___ lives - ✔✔100,000 +
✔✔When insurance coverage is being verified, which of the following is NOT a method
on which to rely? - ✔✔patient
✔✔When a fee ticket (encounter form) is not completed, what procedure would NOT be
acceptable? - ✔✔no charge
✔✔Information about deductibles, copays, eligibility dates, and benefit plans is
completed during what step? - ✔✔verify benefits
✔✔determine primary and secondary coverage - ✔✔birthday rule
✔✔Which of the following is NOT considered a part of the authorized process when the
patient signs the consent for payment? - ✔✔auth for treatment
✔✔Patient types help to classify the patients based on - ✔✔payer, ins type
✔✔Life Cycle of a Claim - ✔✔submission
processing
adjudication
payment/denial
✔✔What authorizes information to be sent to the insurance payer so payment of
medical benefits can be processed? - ✔✔consent for payment
