AAPC CPB PRACTICE EXAM 100% SOLVED
QUESTIONS AND ANSWERS
Joe band bMary bare ba bmarried bcouple band bboth bcarry binsurance bfrom btheir bemployers. bJoe bwas bborn
bon bFebruary b23, b1977 band bMary bwas bborn bon bApril b4, b1974. bUsing bthe bbirthday brule, bwho bcarries
bthe bprimary binsurance bfor btheir bchildren bfor bbilling?
A. bJoe, bbecause bhe bis bthe bmale bhead bof bthe bhousehold. b
B. bMary, bbecause bher bdate bof bbirth bis bthe b4th band bJoe's bdate bof bbirth bis bthe b23rd. b
C. bMary, bbecause bher bbirth byear bis bbefore bJoe's bbirth byear. b
D. bJoe, bbecause bhis bbirth bmonth band bday bare bbefore bMary's bbirth bmonth band bday. b- bD. bJoe,
bbecause bhis bbirth bmonth band bday bare bbefore bMary's bbirth bmonth band bday.
Which btype bof bmanaged bcare binsurance ballows bpatients bto bself-refer bto bout-of-network bproviders
band bpay ba bhigher bco-insurance/copay bamount? b
I. bHMO
II. bPPO
III. bEPO
IV. bPOS
V. bCapitation
A. bII b
B. bIV b
C. bII band bIV b
D. bII, bIII, band bV b- bC. bII band bIV
A bpatient bcovered bby ba bPPO bis bscheduled bfor bknee breplacement bsurgery. bThe bbiller bcontacts bthe
binsurance bcarrier bto bverify bbenefits band bpreauthorize bthe bprocedure. bThe bcarrier bverifies bthe
bpatient bhas ba b$500 bdeductible bwhich bmust bbe bmet. bAfter bthe bdeductible, bthe bPPO bwill bpay b80%
bof bthe bclaim. bThe bcontracted brate bfor bthe bprocedure bis b$2,500. bWhat bis bthe bpatient's
bresponsibility?
,A. b$400 b
B. b$500 b
C. b$900 b
D. b$1,600 b- bC. b$900
When ba bnonparticipating bprovider bfiles ba bclaim bfor ba bpatient bto bBC/BS, bhow bis bthe bpayment
bprocessed? b
A. bThe bpayment bis bsent bto bthe bpatient band bthe bpatient bmust bpay bthe bprovider. b
B. bThe bpayment bis bsent bto bthe bprovider bif bthe bprovider bagrees bto baccept bassignment. b
C. bThe bpayment bis bsent bto bthe bprovider bregardless bif bhe baccepts bassignment. b
D. bThe bclaim bis bnot bpaid bbecause bthe bprovider bis bnot bparticipating bin bthe bplan. b- bA. bThe bpayment
bis bsent bto bthe bpatient band bthe bpatient bmust bpay bthe bprovider.
Which bof bthe bfollowing bTRICARE boptions bis/are bavailable bto bactive bduty bservice bmembers?
b
A. bTRICARE bSelect b
B. bTRICARE bPrime b
C. bTRICARE bFor bLife b
D. bTRICARE bYoung bAdult b- bB. bTRICARE bPrime
A bMedicare bcard bwill blist bwhich bof bthe bfollowing:
b
I. bEffective bdate bof bcoverage
II. bHome baddress
III. bTelephone bNumber
IV. bEntitled bto bPart bA band/or bPart bB
V. bWhen bcoverage bends
VI. bName bof bPrimary bCare bPhysician
b
A. bI b- bVI b
B. bI, bIV b
,C. bI-III, bVI b
D. bI, bII, bIV, bV b- bB. bI, bIV
In bwhich bof bthe bfollowing bscenarios bis bMedicare bthe bsecondary bpayer?
I. bA b65 byear-old bpatient bwho bis bcollecting bher bdeceased bspouse's bMedicare bbenefits band bhas ba
bsupplemental binsurance
II. bA b72 byear-old bpatient bwho bparticipates bin bthe bgroup bhealth binsurance bof bhis bemployer
III. bA b66 byear-old bpatient bis binjured bat bwork band bthe bemployer bdoes bnot boffer bhealth binsurance bas
ba bbenefit bof bemployment
IV. bA b55 byear-old bpatient bwho bis bon bdisability bthrough bSocial bSecurity band bqualifies bfor bMedicaid
band bMedicare b
A. bI-IV b
B. bII band bIII b
C. bI band bIV b
D. bNone b- bB. bII band bIII
When ba bpatient bhas bMedicare bprimary band bAARP bas bMedigap, bwhat bis bentered bon bthe bCMS-1500
bclaim bform bin bitem b9d bfor bthe bInsurance bPlan bName bor bProgram bName bfor bMedicare bto bcross
bover bthe bclaim?
b
A. bPlan bname bfollowed bby b"MEDIGAP" b
B. bPlan bPayer bID bfollowed bby b"MEDIGAP" b
C. bCOBA bMedigap bclaim-based bidentifier b(ID) b
D. bLeave bblank b- bC. bCOBA bMedigap bclaim-based bidentifier b(ID)
Which bguidelines bmust ball bbilling bpersonnel bbe bknowledgeable babout bin border bto bensure
bcompliance bwith bMedicaid bprograms?
b
A. bFederal bguidelines b
B. bState bguidelines b
C. bBoth bA band bB b
D. bNone b- bC. bBoth bA band bB
, Which bof bthe bfollowing bservices bis bcovered bby bEarly band bPeriodic bScreening, bDiagnostic, band
bTreatment b(EPSDT)?
b
A. bFamily bplanning b
B. bObstetric bcare b
C. bPediatric bcheckups b
D. bEmergency bdepartment bvisits b- bC. bPediatric bcheckups
A bfemale bpatient bwho bwas binvolved bin ban bauto baccident bpresents bto bthe bemergency bdepartment
b(ED) bfor bevaluation. bShe bdoes bnot bhave bany bcomplaints. bThe bprovider bevaluates bher band
bdetermines bthere bare bno binjuries. bThe bprovider binforms bthe bpatient bto bcome bback bto bthe bED bor
bsee bher bprimary bcare bphysician bif bshe bdevelops bany bsymptoms. bHow bis bthe bclaim bprocessed bfor
bthis bencounter? b
A. bThe bmedical binsurance bis bbilled bprimary band bthe bauto binsurance bis bbilled bsecondary. b
B. bThe bauto binsurance bis bbilled bprimary band bthe bmedical binsurance bis bbilled bsecondary. b
C. bBill bthe bmedical binsurance bfirst bto breceive ba bdenial band bthen bsubmit bwith bthe bremittance badvice
bto bthe bauto binsurance. b
D. bBill bonly bthe bmedical binsurance bbecause bthe bauto binsurance bonly bcovers bdamage bto bthe bvehicle,
bnot bmedical bexpenses. b- bB. bThe bauto binsurance bis bbilled bprimary band bthe bmedical binsurance bis
bbilled bsecondary.
What bforms bneed bto bbe bsubmitted bwhen bbilling bfor ba bwork-related binjury?
b
A. bProgress breports, band bWC-1500 bclaim bform b
B. bUB-04 b
C. bFirst bReport bof bInjury bform band ban bitemized bstatement b
D. bFirst bReport bof bInjury bform, bprogress breports, band bCMS-1500 bclaim bform b- bD. bFirst bReport bof
bInjury bform, bprogress breports, band bCMS-1500 bclaim bform
A bdocument bprovided bto bMedicare bpatients bexplaining btheir bfinancial bresponsibility bif bMedicare
bdenies ba bservice bis ba(n):
b
A. bNotice bof bFinancial bLiability b
B. bAdvance bBeneficiary bNotice b
C. bInsurance bwaiver b
QUESTIONS AND ANSWERS
Joe band bMary bare ba bmarried bcouple band bboth bcarry binsurance bfrom btheir bemployers. bJoe bwas bborn
bon bFebruary b23, b1977 band bMary bwas bborn bon bApril b4, b1974. bUsing bthe bbirthday brule, bwho bcarries
bthe bprimary binsurance bfor btheir bchildren bfor bbilling?
A. bJoe, bbecause bhe bis bthe bmale bhead bof bthe bhousehold. b
B. bMary, bbecause bher bdate bof bbirth bis bthe b4th band bJoe's bdate bof bbirth bis bthe b23rd. b
C. bMary, bbecause bher bbirth byear bis bbefore bJoe's bbirth byear. b
D. bJoe, bbecause bhis bbirth bmonth band bday bare bbefore bMary's bbirth bmonth band bday. b- bD. bJoe,
bbecause bhis bbirth bmonth band bday bare bbefore bMary's bbirth bmonth band bday.
Which btype bof bmanaged bcare binsurance ballows bpatients bto bself-refer bto bout-of-network bproviders
band bpay ba bhigher bco-insurance/copay bamount? b
I. bHMO
II. bPPO
III. bEPO
IV. bPOS
V. bCapitation
A. bII b
B. bIV b
C. bII band bIV b
D. bII, bIII, band bV b- bC. bII band bIV
A bpatient bcovered bby ba bPPO bis bscheduled bfor bknee breplacement bsurgery. bThe bbiller bcontacts bthe
binsurance bcarrier bto bverify bbenefits band bpreauthorize bthe bprocedure. bThe bcarrier bverifies bthe
bpatient bhas ba b$500 bdeductible bwhich bmust bbe bmet. bAfter bthe bdeductible, bthe bPPO bwill bpay b80%
bof bthe bclaim. bThe bcontracted brate bfor bthe bprocedure bis b$2,500. bWhat bis bthe bpatient's
bresponsibility?
,A. b$400 b
B. b$500 b
C. b$900 b
D. b$1,600 b- bC. b$900
When ba bnonparticipating bprovider bfiles ba bclaim bfor ba bpatient bto bBC/BS, bhow bis bthe bpayment
bprocessed? b
A. bThe bpayment bis bsent bto bthe bpatient band bthe bpatient bmust bpay bthe bprovider. b
B. bThe bpayment bis bsent bto bthe bprovider bif bthe bprovider bagrees bto baccept bassignment. b
C. bThe bpayment bis bsent bto bthe bprovider bregardless bif bhe baccepts bassignment. b
D. bThe bclaim bis bnot bpaid bbecause bthe bprovider bis bnot bparticipating bin bthe bplan. b- bA. bThe bpayment
bis bsent bto bthe bpatient band bthe bpatient bmust bpay bthe bprovider.
Which bof bthe bfollowing bTRICARE boptions bis/are bavailable bto bactive bduty bservice bmembers?
b
A. bTRICARE bSelect b
B. bTRICARE bPrime b
C. bTRICARE bFor bLife b
D. bTRICARE bYoung bAdult b- bB. bTRICARE bPrime
A bMedicare bcard bwill blist bwhich bof bthe bfollowing:
b
I. bEffective bdate bof bcoverage
II. bHome baddress
III. bTelephone bNumber
IV. bEntitled bto bPart bA band/or bPart bB
V. bWhen bcoverage bends
VI. bName bof bPrimary bCare bPhysician
b
A. bI b- bVI b
B. bI, bIV b
,C. bI-III, bVI b
D. bI, bII, bIV, bV b- bB. bI, bIV
In bwhich bof bthe bfollowing bscenarios bis bMedicare bthe bsecondary bpayer?
I. bA b65 byear-old bpatient bwho bis bcollecting bher bdeceased bspouse's bMedicare bbenefits band bhas ba
bsupplemental binsurance
II. bA b72 byear-old bpatient bwho bparticipates bin bthe bgroup bhealth binsurance bof bhis bemployer
III. bA b66 byear-old bpatient bis binjured bat bwork band bthe bemployer bdoes bnot boffer bhealth binsurance bas
ba bbenefit bof bemployment
IV. bA b55 byear-old bpatient bwho bis bon bdisability bthrough bSocial bSecurity band bqualifies bfor bMedicaid
band bMedicare b
A. bI-IV b
B. bII band bIII b
C. bI band bIV b
D. bNone b- bB. bII band bIII
When ba bpatient bhas bMedicare bprimary band bAARP bas bMedigap, bwhat bis bentered bon bthe bCMS-1500
bclaim bform bin bitem b9d bfor bthe bInsurance bPlan bName bor bProgram bName bfor bMedicare bto bcross
bover bthe bclaim?
b
A. bPlan bname bfollowed bby b"MEDIGAP" b
B. bPlan bPayer bID bfollowed bby b"MEDIGAP" b
C. bCOBA bMedigap bclaim-based bidentifier b(ID) b
D. bLeave bblank b- bC. bCOBA bMedigap bclaim-based bidentifier b(ID)
Which bguidelines bmust ball bbilling bpersonnel bbe bknowledgeable babout bin border bto bensure
bcompliance bwith bMedicaid bprograms?
b
A. bFederal bguidelines b
B. bState bguidelines b
C. bBoth bA band bB b
D. bNone b- bC. bBoth bA band bB
, Which bof bthe bfollowing bservices bis bcovered bby bEarly band bPeriodic bScreening, bDiagnostic, band
bTreatment b(EPSDT)?
b
A. bFamily bplanning b
B. bObstetric bcare b
C. bPediatric bcheckups b
D. bEmergency bdepartment bvisits b- bC. bPediatric bcheckups
A bfemale bpatient bwho bwas binvolved bin ban bauto baccident bpresents bto bthe bemergency bdepartment
b(ED) bfor bevaluation. bShe bdoes bnot bhave bany bcomplaints. bThe bprovider bevaluates bher band
bdetermines bthere bare bno binjuries. bThe bprovider binforms bthe bpatient bto bcome bback bto bthe bED bor
bsee bher bprimary bcare bphysician bif bshe bdevelops bany bsymptoms. bHow bis bthe bclaim bprocessed bfor
bthis bencounter? b
A. bThe bmedical binsurance bis bbilled bprimary band bthe bauto binsurance bis bbilled bsecondary. b
B. bThe bauto binsurance bis bbilled bprimary band bthe bmedical binsurance bis bbilled bsecondary. b
C. bBill bthe bmedical binsurance bfirst bto breceive ba bdenial band bthen bsubmit bwith bthe bremittance badvice
bto bthe bauto binsurance. b
D. bBill bonly bthe bmedical binsurance bbecause bthe bauto binsurance bonly bcovers bdamage bto bthe bvehicle,
bnot bmedical bexpenses. b- bB. bThe bauto binsurance bis bbilled bprimary band bthe bmedical binsurance bis
bbilled bsecondary.
What bforms bneed bto bbe bsubmitted bwhen bbilling bfor ba bwork-related binjury?
b
A. bProgress breports, band bWC-1500 bclaim bform b
B. bUB-04 b
C. bFirst bReport bof bInjury bform band ban bitemized bstatement b
D. bFirst bReport bof bInjury bform, bprogress breports, band bCMS-1500 bclaim bform b- bD. bFirst bReport bof
bInjury bform, bprogress breports, band bCMS-1500 bclaim bform
A bdocument bprovided bto bMedicare bpatients bexplaining btheir bfinancial bresponsibility bif bMedicare
bdenies ba bservice bis ba(n):
b
A. bNotice bof bFinancial bLiability b
B. bAdvance bBeneficiary bNotice b
C. bInsurance bwaiver b
