AAPC CPB FINAL ACTUAL EXAM QUESTIONS WITH
COMPLETE SOLUTIONS GUARANTEED PASS BRAND NEW
2025
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. -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 -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 -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 assignment.
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. -ANSWER ->A. The payment is sent to
the patient and the patient must pay the provider.
,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 -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 -ANSWER ->B. I, IV
In which of the following scenarios is Medicare the secondary
payer?
I. A 65 year-old patient who is collecting her deceased spouse's
Medicare benefits and has a supplemental insurance
, II. A 72 year-old patient who participates in the group health
insurance of his employer
III. A 66 year-old patient is injured at work and the employer
does not offer health insurance as a benefit of employment
IV. A 55 year-old patient who is on disability through Social
Security and qualifies for Medicaid and Medicare
A. I-IV
B. II and III
C. I and IV
D. None -ANSWER ->B. II and III
When a patient has Medicare primary and AARP as Medigap,
what is entered on the CMS-1500 claim form in item 9d for the
Insurance Plan Name or Program Name for Medicare to cross
over the claim?
A. Plan name followed by "MEDIGAP"
B. Plan Payer ID followed by "MEDIGAP"
C. COBA Medigap claim-based identifier (ID)
D. Leave blank -ANSWER ->C. COBA Medigap claim-based
identifier (ID)
Which guidelines must all billing personnel be knowledgeable
about in order to ensure compliance with Medicaid programs?
A. Federal guidelines
B. State guidelines
C. Both A and B
COMPLETE SOLUTIONS GUARANTEED PASS BRAND NEW
2025
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. -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 -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 -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 assignment.
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. -ANSWER ->A. The payment is sent to
the patient and the patient must pay the provider.
,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 -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 -ANSWER ->B. I, IV
In which of the following scenarios is Medicare the secondary
payer?
I. A 65 year-old patient who is collecting her deceased spouse's
Medicare benefits and has a supplemental insurance
, II. A 72 year-old patient who participates in the group health
insurance of his employer
III. A 66 year-old patient is injured at work and the employer
does not offer health insurance as a benefit of employment
IV. A 55 year-old patient who is on disability through Social
Security and qualifies for Medicaid and Medicare
A. I-IV
B. II and III
C. I and IV
D. None -ANSWER ->B. II and III
When a patient has Medicare primary and AARP as Medigap,
what is entered on the CMS-1500 claim form in item 9d for the
Insurance Plan Name or Program Name for Medicare to cross
over the claim?
A. Plan name followed by "MEDIGAP"
B. Plan Payer ID followed by "MEDIGAP"
C. COBA Medigap claim-based identifier (ID)
D. Leave blank -ANSWER ->C. COBA Medigap claim-based
identifier (ID)
Which guidelines must all billing personnel be knowledgeable
about in order to ensure compliance with Medicaid programs?
A. Federal guidelines
B. State guidelines
C. Both A and B
