AAPC CPB |ACTUAL QUESTIONS AND VERIFIED
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
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.
CORRECT ANSWER
D. Joe, because his birth month and day are before Mary's birth month and day.
Question 2
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
1
,B. IV
C. II and IV
D. II, III, and V
CORRECT ANSWER
C. II and IV
Question 3
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
CORRECT ANSWER
C. $900
Question 4
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.
C. The payment is sent to the provider regardless if he accepts assignment.
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, D. The claim is not paid because the provider is not participating in the plan.
CORRECT ANSWER
A. The payment is sent to the patient and the patient must pay the provider.
Question 5
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
CORRECT ANSWER
B. TRICARE Prime
Question 6
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
V. When coverage ends
VI. Name of Primary Care Physician
A. I - VI
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ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
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.
CORRECT ANSWER
D. Joe, because his birth month and day are before Mary's birth month and day.
Question 2
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
1
,B. IV
C. II and IV
D. II, III, and V
CORRECT ANSWER
C. II and IV
Question 3
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
CORRECT ANSWER
C. $900
Question 4
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.
C. The payment is sent to the provider regardless if he accepts assignment.
2
, D. The claim is not paid because the provider is not participating in the plan.
CORRECT ANSWER
A. The payment is sent to the patient and the patient must pay the provider.
Question 5
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
CORRECT ANSWER
B. TRICARE Prime
Question 6
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
V. When coverage ends
VI. Name of Primary Care Physician
A. I - VI
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