AAPC CPB Test Bank Questions with Complete Solution b b b b b b b
s 2022 Graded A+
b b b b
Joe and Mary are a married couple and both carry insurance from their employers. Jo
b b b b b b b b b b b b b b
e was born on February 23, 1977 and Mary was born on April 4, 1974. Using thebirth
b b b b b b b b b b b b b b b b b
day rule, who carries the primary insurance for their children for billing?
b b b b b b b b b b b
A. Joe, because he is the male head of the household.
b b b b b b b b b
B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd.
b b b b b b b b b b b b b b b b
C. Mary, because her birth year is before Joe's birth year.
b b b b b b b b b
D. Joe, because his birth month and day are before Mary's birth month and day. Co
b b b b b b b b b b b b b b
rrect Answer: D. Joe, because his birth month and day are before Mary's birthmont
b b b b b b b b b b b b b b
h and day.
b b
Which type of managed care insurance allows patients to self-refer to out-of-
b b b b b b b b b b b
network providers and pay a higher co-insurance/copay amount?
b b b b b b b b
I. HMO
II. PPO
III. EPO
IV. POS
V. Capitation
A. II
B. IV
C. II and IV b b
D. II, III, and V Correct Answer: C. II and IV
b b b b b b b b b
A patient covered by a PPO is scheduled for knee replacement surgery. The billercon
b b b b b b b b b b b b b b
tacts the insurance carrier to verify benefits and preauthorize the procedure.
b b b b b b b b b b
The carrier verifies the patient has a $500 deductible which must be met. After thede
b b b b b b b b b b b b b b b
ductible, the PPO will pay 80% of the claim. The contracted rate for the procedure is
b b b b b b b b b b b b b b b b
$2,500. What is the patient's responsibility?
b b b b b
A. $400 b
B. $500 b
C. $900 b
D. $1,600 Correct Answer: C. $900
b b b b b
AAPC CPB Test Bank Questions with Complete Solution b b b b b b b
s 2022 Graded A+
b b b b
,AAPC CPB Test Bank Questions with Complete Solution
b b b b b b b
s 2022 Graded A+
b b b b
When a nonparticipating provider files a claim for a patient to BC/BS, how is thepay
b b b b b b b b b b b b b b b
ment processed? b
A. The payment is sent to the patient and the patient must pay the provider.
b b b b b b b b b b b b b
B. The payment is sent to the provider if the provider agrees to accept assignment.
b b b b b b b b b b b b b
C. The payment is sent to the provider regardless if he accepts assignment.
b b b b b b b b b b b
D. The claim is not paid because the provider is not participating in the plan. Correct
b b b b b b b b b b b b b b b
Answer: A. The payment is sent to the patient and the patient must pay theprovider.
b b b b b b b b b b b b b b b
Which of the following TRICARE options is/are available to active duty serviceme
b b b b b b b b b b b b
mbers?
A. TRICARE Select b
B. TRICARE Prime b
C. TRICARE For Life b b
D. TRICARE Young Adult Correct Answer: B. TRICARE PrimeA b b b b b b b b
Medicare card will list which of the following:
b b b b b b b b
I. Effective date of coverage b b b
II. Home address b
III. Telephone Number b
IV. Entitled to Part A and/or Part B b b b b b b
V. When coverage ends b b
VI. Name of Primary Care Physician b b b b
A. I - VI b b
B. I, IV b
C. I-III, VI b
D. I, II, IV, V Correct Answer: B. I, IV
b b b b b b b b
In which of the following scenarios is Medicare the secondary payer?
b b b b b b b b b b
I. A 65 year- b b
old patient who is collecting her deceased spouse's Medicare benefitsand has a supp
b b b b b b b b b b b b b
lemental insurance b
II. A 72 year- b b
old patient who participates in the group health insurance of hisemployer
b b b b b b b b b b b
AAPC CPB Test Bank Questions with Complete Solution
b b b b b b b
s 2022 Graded A+
b b b b
,AAPC CPB Test Bank Questions with Complete Solution
b b b b b b b
s 2022 Graded A+
b b b b
III. A 66 year- b b
old patient is injured at work and the employer does not offer healthinsurance as a b
b b b b b b b b b b b b b b b b
enefit of employment b b
IV. A 55 year- b b
old patient who is on disability through Social Security and qualifiesfor Medicaid an
b b b b b b b b b b b b b
d Medicare
b
A. I-IV
B. II and III b b
C. I and IV b b
D. None Correct Answer: B. II and III b b b b b b
When a patient has Medicare primary and AARP as Medigap, what is entered onthe
b b b b b b b b b b b b b b b
CMS-
1500 claim form in item 9d for the Insurance Plan Name or Program Name for Medi
b b b b b b b b b b b b b b b
care to cross over the claim?
b b b b b
A. Plan name followed by "MEDIGAP" b b b b
B. Plan Payer ID followed by "MEDIGAP"
b b b b b
C. COBA Medigap claim-based identifier (ID) b b b b
D. Leave blank Correct Answer: C. COBA Medigap claim-based identifier (ID)
b b b b b b b b b
Which guidelines must all billing personnel be knowledgeable about in order toensu
b b b b b b b b b b b b
re compliance with Medicaid programs?
b b b b
A. Federal guidelines b
B. State guidelines b
C. Both A and B b b b
D. None Correct Answer: C. Both A and B b b b b b b b
Which of the following services is covered by Early and Periodic Screening,Diagnos
b b b b b b b b b b b b
tic, and Treatment (EPSDT)?
b b b
A. Family planning b
B. Obstetric care b
C. Pediatric checkups b
D. Emergency department visits Correct Answer: C. Pediatric checkups b b b b b b b
A female patient who was involved in an auto accident presents to the emergency depa
b b b b b b b b b b b b b b
AAPC CPB Test Bank Questions with Complete Solution
b b b b b b b
s 2022 Graded A+
b b b b
, AAPC CPB Test Bank Questions with Complete Solution
b b b b b b b
s 2022 Graded A+
b b b b
rtment (ED) for evaluation. She does not have any complaints. The provider evaluates
b b b b b b b b b b b b b
her and determines there are no injuries. The provider informs the patientto come back
b b b b b b b b b b b b b b
bto the ED or see her primary care physician if she develops any symptoms. How is the
b b b b b b b b b b b b b b b b b
claim processed for this encounter?
b b b b
AAPC CPB Test Bank Questions with Complete Solution
b b b b b b b
s 2022 Graded A+
b b b b
s 2022 Graded A+
b b b b
Joe and Mary are a married couple and both carry insurance from their employers. Jo
b b b b b b b b b b b b b b
e was born on February 23, 1977 and Mary was born on April 4, 1974. Using thebirth
b b b b b b b b b b b b b b b b b
day rule, who carries the primary insurance for their children for billing?
b b b b b b b b b b b
A. Joe, because he is the male head of the household.
b b b b b b b b b
B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd.
b b b b b b b b b b b b b b b b
C. Mary, because her birth year is before Joe's birth year.
b b b b b b b b b
D. Joe, because his birth month and day are before Mary's birth month and day. Co
b b b b b b b b b b b b b b
rrect Answer: D. Joe, because his birth month and day are before Mary's birthmont
b b b b b b b b b b b b b b
h and day.
b b
Which type of managed care insurance allows patients to self-refer to out-of-
b b b b b b b b b b b
network providers and pay a higher co-insurance/copay amount?
b b b b b b b b
I. HMO
II. PPO
III. EPO
IV. POS
V. Capitation
A. II
B. IV
C. II and IV b b
D. II, III, and V Correct Answer: C. II and IV
b b b b b b b b b
A patient covered by a PPO is scheduled for knee replacement surgery. The billercon
b b b b b b b b b b b b b b
tacts the insurance carrier to verify benefits and preauthorize the procedure.
b b b b b b b b b b
The carrier verifies the patient has a $500 deductible which must be met. After thede
b b b b b b b b b b b b b b b
ductible, the PPO will pay 80% of the claim. The contracted rate for the procedure is
b b b b b b b b b b b b b b b b
$2,500. What is the patient's responsibility?
b b b b b
A. $400 b
B. $500 b
C. $900 b
D. $1,600 Correct Answer: C. $900
b b b b b
AAPC CPB Test Bank Questions with Complete Solution b b b b b b b
s 2022 Graded A+
b b b b
,AAPC CPB Test Bank Questions with Complete Solution
b b b b b b b
s 2022 Graded A+
b b b b
When a nonparticipating provider files a claim for a patient to BC/BS, how is thepay
b b b b b b b b b b b b b b b
ment processed? b
A. The payment is sent to the patient and the patient must pay the provider.
b b b b b b b b b b b b b
B. The payment is sent to the provider if the provider agrees to accept assignment.
b b b b b b b b b b b b b
C. The payment is sent to the provider regardless if he accepts assignment.
b b b b b b b b b b b
D. The claim is not paid because the provider is not participating in the plan. Correct
b b b b b b b b b b b b b b b
Answer: A. The payment is sent to the patient and the patient must pay theprovider.
b b b b b b b b b b b b b b b
Which of the following TRICARE options is/are available to active duty serviceme
b b b b b b b b b b b b
mbers?
A. TRICARE Select b
B. TRICARE Prime b
C. TRICARE For Life b b
D. TRICARE Young Adult Correct Answer: B. TRICARE PrimeA b b b b b b b b
Medicare card will list which of the following:
b b b b b b b b
I. Effective date of coverage b b b
II. Home address b
III. Telephone Number b
IV. Entitled to Part A and/or Part B b b b b b b
V. When coverage ends b b
VI. Name of Primary Care Physician b b b b
A. I - VI b b
B. I, IV b
C. I-III, VI b
D. I, II, IV, V Correct Answer: B. I, IV
b b b b b b b b
In which of the following scenarios is Medicare the secondary payer?
b b b b b b b b b b
I. A 65 year- b b
old patient who is collecting her deceased spouse's Medicare benefitsand has a supp
b b b b b b b b b b b b b
lemental insurance b
II. A 72 year- b b
old patient who participates in the group health insurance of hisemployer
b b b b b b b b b b b
AAPC CPB Test Bank Questions with Complete Solution
b b b b b b b
s 2022 Graded A+
b b b b
,AAPC CPB Test Bank Questions with Complete Solution
b b b b b b b
s 2022 Graded A+
b b b b
III. A 66 year- b b
old patient is injured at work and the employer does not offer healthinsurance as a b
b b b b b b b b b b b b b b b b
enefit of employment b b
IV. A 55 year- b b
old patient who is on disability through Social Security and qualifiesfor Medicaid an
b b b b b b b b b b b b b
d Medicare
b
A. I-IV
B. II and III b b
C. I and IV b b
D. None Correct Answer: B. II and III b b b b b b
When a patient has Medicare primary and AARP as Medigap, what is entered onthe
b b b b b b b b b b b b b b b
CMS-
1500 claim form in item 9d for the Insurance Plan Name or Program Name for Medi
b b b b b b b b b b b b b b b
care to cross over the claim?
b b b b b
A. Plan name followed by "MEDIGAP" b b b b
B. Plan Payer ID followed by "MEDIGAP"
b b b b b
C. COBA Medigap claim-based identifier (ID) b b b b
D. Leave blank Correct Answer: C. COBA Medigap claim-based identifier (ID)
b b b b b b b b b
Which guidelines must all billing personnel be knowledgeable about in order toensu
b b b b b b b b b b b b
re compliance with Medicaid programs?
b b b b
A. Federal guidelines b
B. State guidelines b
C. Both A and B b b b
D. None Correct Answer: C. Both A and B b b b b b b b
Which of the following services is covered by Early and Periodic Screening,Diagnos
b b b b b b b b b b b b
tic, and Treatment (EPSDT)?
b b b
A. Family planning b
B. Obstetric care b
C. Pediatric checkups b
D. Emergency department visits Correct Answer: C. Pediatric checkups b b b b b b b
A female patient who was involved in an auto accident presents to the emergency depa
b b b b b b b b b b b b b b
AAPC CPB Test Bank Questions with Complete Solution
b b b b b b b
s 2022 Graded A+
b b b b
, AAPC CPB Test Bank Questions with Complete Solution
b b b b b b b
s 2022 Graded A+
b b b b
rtment (ED) for evaluation. She does not have any complaints. The provider evaluates
b b b b b b b b b b b b b
her and determines there are no injuries. The provider informs the patientto come back
b b b b b b b b b b b b b b
bto the ED or see her primary care physician if she develops any symptoms. How is the
b b b b b b b b b b b b b b b b b
claim processed for this encounter?
b b b b
AAPC CPB Test Bank Questions with Complete Solution
b b b b b b b
s 2022 Graded A+
b b b b
