AAPC CPB - Practice Exam C Questions
& Answers 100% Correct!
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. Mother's insurance plan
B. Father's insurance plan
C. The policy that has the best benefits
D. Either mother's or father's insurance plan depending who brings the child in for
medical care. - ANSWERSA. Mother's insurance plan
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) - ANSWERSC. Exclusive Provider Organization
(EPO)
Which TRICARE plan is similar to an HMO plan?
A. TRICARE For Life
B. TRICARE Select
C. TRICARE Prime
D. TRICARE Young Adult - ANSWERSC. TRICARE Prime
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
V. Home Health Services
VI. Long Term Care
VII. Outpatient prescription drugs
A. I-VII
B. II, III, VI
C. I, II, IV, VII
D. I, IV, V - ANSWERSD. I, IV, V
, Which is a TRUE statement regarding Workers' Compensation?
A. There is no copayment for the injured worker in workers' compensation cases.
B. The filing deadline for a first report of injury form is one week from the date of the
accident.
C. Providers can balance bill a patient when compensation payment is not paid in full.
D. There is a deductible for the injured worker in workers' compensation claims. -
ANSWERSA. There is no copayment for the injured worker in workers' compensation
cases.
Bob sees his family physician for seasonal allergies. Before leaving, Bob pays the
charge for the office visit. As a courtesy, the physician's staff submits a claim to Bob's
insurance company. If the service is covered by the insurance company, Bob can
expect to be reimbursed for the office visit. This is which type of insurance model?
A. Healthcare Anywhere
B. Managed Care Plan
C. Fee-for-service (traditional coverage)
D. Health Maintenance Organization (HMO) - ANSWERSC. Fee-for-service (traditional
coverage)
Which of the following benefits are NOT covered by all Medigap policies?
I. Part A co-insurance and hospital costs
II. Skilled nursing facility care co-insurance
III. Parts A & B deductible
IV. Part B excess charges
V. Foreign travel exchange
A. I, II, III
B. I, III
C. I, IV, V
D. II, III, IV, V - ANSWERSD. II, III, IV, V
Medicaid eligibility is primarily determined by?
A. Income
B. Prior insurance coverage
C. Marital status
D. Number of living relatives - ANSWERSA. Income
____________ is incorporated by CMS into the NCCI program to limit the number of
times a service or procedure can be reported by a physician on the same date of
service to a patient.
A. Outpatient Code Editor (OCE)
B. Medically Unlikely Edits (MUE)
& Answers 100% Correct!
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. Mother's insurance plan
B. Father's insurance plan
C. The policy that has the best benefits
D. Either mother's or father's insurance plan depending who brings the child in for
medical care. - ANSWERSA. Mother's insurance plan
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) - ANSWERSC. Exclusive Provider Organization
(EPO)
Which TRICARE plan is similar to an HMO plan?
A. TRICARE For Life
B. TRICARE Select
C. TRICARE Prime
D. TRICARE Young Adult - ANSWERSC. TRICARE Prime
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
V. Home Health Services
VI. Long Term Care
VII. Outpatient prescription drugs
A. I-VII
B. II, III, VI
C. I, II, IV, VII
D. I, IV, V - ANSWERSD. I, IV, V
, Which is a TRUE statement regarding Workers' Compensation?
A. There is no copayment for the injured worker in workers' compensation cases.
B. The filing deadline for a first report of injury form is one week from the date of the
accident.
C. Providers can balance bill a patient when compensation payment is not paid in full.
D. There is a deductible for the injured worker in workers' compensation claims. -
ANSWERSA. There is no copayment for the injured worker in workers' compensation
cases.
Bob sees his family physician for seasonal allergies. Before leaving, Bob pays the
charge for the office visit. As a courtesy, the physician's staff submits a claim to Bob's
insurance company. If the service is covered by the insurance company, Bob can
expect to be reimbursed for the office visit. This is which type of insurance model?
A. Healthcare Anywhere
B. Managed Care Plan
C. Fee-for-service (traditional coverage)
D. Health Maintenance Organization (HMO) - ANSWERSC. Fee-for-service (traditional
coverage)
Which of the following benefits are NOT covered by all Medigap policies?
I. Part A co-insurance and hospital costs
II. Skilled nursing facility care co-insurance
III. Parts A & B deductible
IV. Part B excess charges
V. Foreign travel exchange
A. I, II, III
B. I, III
C. I, IV, V
D. II, III, IV, V - ANSWERSD. II, III, IV, V
Medicaid eligibility is primarily determined by?
A. Income
B. Prior insurance coverage
C. Marital status
D. Number of living relatives - ANSWERSA. Income
____________ is incorporated by CMS into the NCCI program to limit the number of
times a service or procedure can be reported by a physician on the same date of
service to a patient.
A. Outpatient Code Editor (OCE)
B. Medically Unlikely Edits (MUE)
