AAPC CPB FINAL |ACTUAL QUESTIONS AND
VERIFIED ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
A 6-year-old is seen in the pediatrician office for the first time. He has insurance coverage
through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose
insurance is primary?
A. Mothers insurance plan
B. Fathers insurance plan
C. The insurance plan with the best benefits
D. Either mother's or father's insurance plan depending who brings the child in for medical
care.
CORRECT ANSWER
A. The mothers insurance
Rationale: The birthday rule states the parent whose birthday falls first in the year is
primary. The year of birth is not relevant. In this case, the mother's birthday falls before
the father's birthday, so the mother's insurance is primary
Question 2
Which managed care plan has the patient receiving care from participating providers
(network provider) and the providers are only paid for services provided?
A. Health Maintenance Organization (HMO)
B. Point-of-Service Plan (POS)
C. Exclusive Provider Organization (EPO)
D. Integrated Delivery System (IDS)
CORRECT ANSWER
1
, C. Exclusive Provider Organization (EPO)
Rationale: EPO is a managed care plan in which enrollees must receive their care from
doctors and hospitals within the EPO network but cannot go outside of the network for
care. If an enrollee goes to a provider or hospital outside of the network the enrollee will
have to pay the medical bills out of pocket. A network provider for EPO plans is
reimbursed on fee-for-service basis
Question 3
Which TRICARE plan is similar to an HMO plan?
A. TRICARE For Life
B. TRICARE Select
C. TRICARE Prime
D. TRICARE Young Adult
CORRECT ANSWER
C. Tricare Prime
Rationale: TRICARE Prime is one of the three healthcare options that is similar to an
HMO plan as the patient is assigned a PCP and the treatment goes through the PCP.
Question 4
Which of the services are covered by Medicare Part A?
I. Skilled Nursing Facility Care
II. Ambulatory Surgery
III. Durable Medical Equipment
IV. Hospice Care
2
VERIFIED ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
A 6-year-old is seen in the pediatrician office for the first time. He has insurance coverage
through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose
insurance is primary?
A. Mothers insurance plan
B. Fathers insurance plan
C. The insurance plan with the best benefits
D. Either mother's or father's insurance plan depending who brings the child in for medical
care.
CORRECT ANSWER
A. The mothers insurance
Rationale: The birthday rule states the parent whose birthday falls first in the year is
primary. The year of birth is not relevant. In this case, the mother's birthday falls before
the father's birthday, so the mother's insurance is primary
Question 2
Which managed care plan has the patient receiving care from participating providers
(network provider) and the providers are only paid for services provided?
A. Health Maintenance Organization (HMO)
B. Point-of-Service Plan (POS)
C. Exclusive Provider Organization (EPO)
D. Integrated Delivery System (IDS)
CORRECT ANSWER
1
, C. Exclusive Provider Organization (EPO)
Rationale: EPO is a managed care plan in which enrollees must receive their care from
doctors and hospitals within the EPO network but cannot go outside of the network for
care. If an enrollee goes to a provider or hospital outside of the network the enrollee will
have to pay the medical bills out of pocket. A network provider for EPO plans is
reimbursed on fee-for-service basis
Question 3
Which TRICARE plan is similar to an HMO plan?
A. TRICARE For Life
B. TRICARE Select
C. TRICARE Prime
D. TRICARE Young Adult
CORRECT ANSWER
C. Tricare Prime
Rationale: TRICARE Prime is one of the three healthcare options that is similar to an
HMO plan as the patient is assigned a PCP and the treatment goes through the PCP.
Question 4
Which of the services are covered by Medicare Part A?
I. Skilled Nursing Facility Care
II. Ambulatory Surgery
III. Durable Medical Equipment
IV. Hospice Care
2
