NURSING 412 AAPC-CPB LATEST 2024-2025 EXAM
WITH QUESTIONS AND ANSWERS GRADED A+
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
thebirthday 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.
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
B. IV
C. II and IV
,D. II, III, and V Correct Answer: C. II and IV
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
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 as
ignment.
C. The payment is sent to the provider regardless if he accepts assignment.
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
theprovider.
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 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
B. I, IV
C. I-III, VI
D. I, II, IV, V Correct Answer: B. I, IV
Incorrect entry of the patient demographics can have an effect on many areas of
thepractice. What documents are necessary to verify demographics?
I. Photo Identification
II. Insurance card
III. Credit card information
IV. Social Security card
V. Patient completed demographic form
A. I and V
WITH QUESTIONS AND ANSWERS GRADED A+
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
thebirthday 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.
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
B. IV
C. II and IV
,D. II, III, and V Correct Answer: C. II and IV
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
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 as
ignment.
C. The payment is sent to the provider regardless if he accepts assignment.
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
theprovider.
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 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
B. I, IV
C. I-III, VI
D. I, II, IV, V Correct Answer: B. I, IV
Incorrect entry of the patient demographics can have an effect on many areas of
thepractice. What documents are necessary to verify demographics?
I. Photo Identification
II. Insurance card
III. Credit card information
IV. Social Security card
V. Patient completed demographic form
A. I and V
