AAPC CPB Practice Exam With
Verified Answers
Joe dand dMary dare da dmarried dcouple dand dboth dcarry dinsurance dfrom dtheir
demployers. dJoe dwas dborn don dFebruary d23, d1977 dand dMary dwas dborn don dApril d4,
d1974. dUsing dthe dbirthday drule, dwho dcarries dthe dprimary dinsurance dfor dtheir
dchildren dfor dbilling?
A. dJoe, dbecause dhe dis dthe dmale dhead dof dthe dhousehold. d
B. dMary, dbecause dher ddate dof dbirth dis dthe d4th dand dJoe's ddate dof dbirth dis dthe
d23rd. d
C. dMary, dbecause dher dbirth dyear dis dbefore dJoe's dbirth dyear. d
D. dJoe, dbecause dhis dbirth dmonth dand dday dare dbefore dMary's dbirth dmonth dand
dday. d- dCORRECT✅✅D. dJoe, dbecause dhis dbirth dmonth dand dday dare dbefore
dMary's dbirth dmonth dand dday.
Which dtype dof dmanaged dcare dinsurance dallows dpatients dto dself-refer dto dout-of-
network dproviders dand dpay da dhigher dco-insurance/copay damount? d
I. dHMO
II. dPPO
III. dEPO
IV. dPOS
V. dCapitation
A. dII d
B. dIV d
C. dII dand dIV d
D. dII, dIII, dand dV d- dCORRECT✅✅C. dII dand dIV
A dpatient dcovered dby da dPPO dis dscheduled dfor dknee dreplacement dsurgery. dThe
dbiller dcontacts dthe dinsurance dcarrier dto dverify dbenefits dand dpreauthorize dthe
dprocedure. dThe dcarrier dverifies dthe dpatient dhas da d$500 ddeductible dwhich dmust dbe
dmet. dAfter dthe ddeductible, dthe dPPO dwill dpay d80% dof dthe dclaim. dThe dcontracted
drate dfor dthe dprocedure dis d$2,500. dWhat dis dthe dpatient's dresponsibility?
A. d$400 d
B. d$500 d
C. d$900 d
D. d$1,600 d- dCORRECT✅✅C. d$900
,When da dnonparticipating dprovider dfiles da dclaim dfor da dpatient dto dBC/BS, dhow dis
dthe dpayment dprocessed? d
A. dThe dpayment dis dsent dto dthe dpatient dand dthe dpatient dmust dpay dthe dprovider. d
B. dThe dpayment dis dsent dto dthe dprovider dif dthe dprovider dagrees dto daccept
dassignment. d
C. dThe dpayment dis dsent dto dthe dprovider dregardless dif dhe daccepts dassignment. d
D. dThe dclaim dis dnot dpaid dbecause dthe dprovider dis dnot dparticipating din dthe dplan. d-
dCORRECT✅✅A. dThe dpayment dis dsent dto dthe dpatient dand dthe dpatient dmust dpay
dthe dprovider.
Which dof dthe dfollowing dTRICARE doptions dis/are davailable dto dactive dduty dservice
dmembers?
d
A. dTRICARE dSelect d
B. dTRICARE dPrime d
C. dTRICARE dFor dLife d
D. dTRICARE dYoung dAdult d- dCORRECT✅✅B. dTRICARE dPrime
A dMedicare dcard dwill dlist dwhich dof dthe dfollowing:
d
I. dEffective ddate dof dcoverage
II. dHome daddress
III. dTelephone dNumber
IV. dEntitled dto dPart dA dand/or dPart dB
V. dWhen dcoverage dends
VI. dName dof dPrimary dCare dPhysician
d
A. dI d- dVI d
B. dI, dIV d
C. dI-III, dVI d
D. dI, dII, dIV, dV d- dCORRECT✅✅B. dI, dIV
In dwhich dof dthe dfollowing dscenarios dis dMedicare dthe dsecondary dpayer?
I. dA d65 dyear-old dpatient dwho dis dcollecting dher ddeceased dspouse's dMedicare
dbenefits dand dhas da dsupplemental dinsurance
II. dA d72 dyear-old dpatient dwho dparticipates din dthe dgroup dhealth dinsurance dof dhis
demployer
III. dA d66 dyear-old dpatient dis dinjured dat dwork dand dthe demployer ddoes dnot doffer
dhealth dinsurance das da dbenefit dof demployment
IV. dA d55 dyear-old dpatient dwho dis don ddisability dthrough dSocial dSecurity dand
dqualifies dfor dMedicaid dand dMedicare d
A. dI-IV d
B. dII dand dIII d
C. dI dand dIV d
,D. dNone d- dCORRECT✅✅B. dII dand dIII
When da dpatient dhas dMedicare dprimary dand dAARP das dMedigap, dwhat dis dentered
don dthe dCMS-1500 dclaim dform din ditem d9d dfor dthe dInsurance dPlan dName dor
dProgram dName dfor dMedicare dto dcross dover dthe dclaim?
d
A. dPlan dname dfollowed dby d"MEDIGAP" d
B. dPlan dPayer dID dfollowed dby d"MEDIGAP" d
C. dCOBA dMedigap dclaim-based didentifier d(ID) d
D. dLeave dblank d- dCORRECT✅✅C. dCOBA dMedigap dclaim-based didentifier d(ID)
Which dguidelines dmust dall dbilling dpersonnel dbe dknowledgeable dabout din dorder dto
densure dcompliance dwith dMedicaid dprograms?
d
A. dFederal dguidelines d
B. dState dguidelines d
C. dBoth dA dand dB d
D. dNone d- dCORRECT✅✅C. dBoth dA dand dB
Which dof dthe dfollowing dservices dis dcovered dby dEarly dand dPeriodic dScreening,
dDiagnostic, dand dTreatment d(EPSDT)?
d
A. dFamily dplanning d
B. dObstetric dcare d
C. dPediatric dcheckups d
D. dEmergency ddepartment dvisits d- dCORRECT✅✅C. dPediatric dcheckups
A dfemale dpatient dwho dwas dinvolved din dan dauto daccident dpresents dto dthe
demergency ddepartment d(ED) dfor devaluation. dShe ddoes dnot dhave dany dcomplaints.
dThe dprovider devaluates dher dand ddetermines dthere dare dno dinjuries. dThe dprovider
dinforms dthe dpatient dto dcome dback dto dthe dED dor dsee dher dprimary dcare dphysician
dif dshe ddevelops dany dsymptoms. dHow dis dthe dclaim dprocessed dfor dthis dencounter? d
A. dThe dmedical dinsurance dis dbilled dprimary dand dthe dauto dinsurance dis dbilled
dsecondary. d
B. dThe dauto dinsurance dis dbilled dprimary dand dthe dmedical dinsurance dis dbilled
dsecondary. d
C. dBill dthe dmedical dinsurance dfirst dto dreceive da ddenial dand dthen dsubmit dwith dthe
dremittance dadvice dto dthe dauto dinsurance. d
D. dBill donly dthe dmedical dinsurance dbecause dthe dauto dinsurance donly dcovers
ddamage dto dthe dvehicle, dnot dmedical dexpenses. d- dCORRECT✅✅B. dThe dauto
dinsurance dis dbilled dprimary dand dthe dmedical dinsurance dis dbilled dsecondary.
What dforms dneed dto dbe dsubmitted dwhen dbilling dfor da dwork-related dinjury?
d
A. dProgress dreports, dand dWC-1500 dclaim dform d
B. dUB-04 d
C. dFirst dReport dof dInjury dform dand dan ditemized dstatement d
, D. dFirst dReport dof dInjury dform, dprogress dreports, dand dCMS-1500 dclaim dform d-
dCORRECT✅✅D. dFirst dReport dof dInjury dform, dprogress dreports, dand dCMS-1500
dclaim dform
A ddocument dprovided dto dMedicare dpatients dexplaining dtheir dfinancial dresponsibility
dif dMedicare ddenies da dservice dis da(n):
d
A. dNotice dof dFinancial dLiability d
B. dAdvance dBeneficiary dNotice d
C. dInsurance dwaiver d
D. dExplanation dof dBenefits d- dCORRECT✅✅B. dAdvance dBeneficiary dNotice
What dis dan dAccountable dCare dOrganization d(ACO)?
d
A. dGroups dof ddoctors, dhospitals, dand dother dhealth dcare dproviders dwho dcoordinate
dhigh dquality dcare dto dMedicare dpatients. d
B. dAn dinsurance dcarrier dthat dprovides da dset dfee dbased don dthe ddiagnosis dof dthe
dpatient. d
C. dA dgroup dof dproviders dwho dcontract dwith da dthird dparty dadministrator dto dpay dfee
dfor dservice dfor dservices. d
D. dHospitals dwho dsee da dsubset dof dpatients dfor dcost defficiency. d-
dCORRECT✅✅A. dGroups dof ddoctors, dhospitals, dand dother dhealth dcare dproviders
dwho dcoordinate dhigh dquality dcare dto dMedicare dpatients.
A dnew dpatient dpresents dfor dher dannual dexam dand dhas dno dcomplaints. dShe dis
dscheduled dto dsee dthe dphysician dassistant d(PA). dHow dshould dservices dbe dbilled d?
d
A. dBill dunder dthe dPA. d
B. dA dnew dpatient dcan dbe dbilled dincident dto dthe dphysician. d
C. dThe dPA dcannot dsee dnew dpatients. d
D. dReschedule dthe dpatient dwith dthe dphysician d- dCORRECT✅✅A. dBill dunder dthe
dPA.
CPT® dcodes d12032 dand d12001 dwere dreported dtogether dfor da d2.6 dcm dintermediate
drepair dof da dlaceration dto dthe dright darm dand da d2.5 dcm dsimple drepair dof da
dlaceration dto dthe dleft darm. d12001 dwas ddenied das da dbundled dservice. dWhat daction
dshould dbe dtaken dby dthe dbiller d(following dthe dCPT® dguidelines)?
d
A. dWrite-off dthe dcharge dfor d12001 das dit dis da dbundled dprocedure. d
B. dResubmit da dcorrected dclaim das d12032, d12001-59. d
C. dTransfer dthe dcharge dto dpatient dresponsibility. d
D. dResubmit da dcorrected dclaim das d12032, d12001-51. d- dCORRECT✅✅B.
dResubmit da dcorrected dclaim das d12032, d12001-59.
According dto dCMS, dwhich dof dthe dfollowing dservices dare dincluded din dthe dglobal
dpackage dfor dsurgical dprocedures?
I. dSurgical dprocedure dperformed
Verified Answers
Joe dand dMary dare da dmarried dcouple dand dboth dcarry dinsurance dfrom dtheir
demployers. dJoe dwas dborn don dFebruary d23, d1977 dand dMary dwas dborn don dApril d4,
d1974. dUsing dthe dbirthday drule, dwho dcarries dthe dprimary dinsurance dfor dtheir
dchildren dfor dbilling?
A. dJoe, dbecause dhe dis dthe dmale dhead dof dthe dhousehold. d
B. dMary, dbecause dher ddate dof dbirth dis dthe d4th dand dJoe's ddate dof dbirth dis dthe
d23rd. d
C. dMary, dbecause dher dbirth dyear dis dbefore dJoe's dbirth dyear. d
D. dJoe, dbecause dhis dbirth dmonth dand dday dare dbefore dMary's dbirth dmonth dand
dday. d- dCORRECT✅✅D. dJoe, dbecause dhis dbirth dmonth dand dday dare dbefore
dMary's dbirth dmonth dand dday.
Which dtype dof dmanaged dcare dinsurance dallows dpatients dto dself-refer dto dout-of-
network dproviders dand dpay da dhigher dco-insurance/copay damount? d
I. dHMO
II. dPPO
III. dEPO
IV. dPOS
V. dCapitation
A. dII d
B. dIV d
C. dII dand dIV d
D. dII, dIII, dand dV d- dCORRECT✅✅C. dII dand dIV
A dpatient dcovered dby da dPPO dis dscheduled dfor dknee dreplacement dsurgery. dThe
dbiller dcontacts dthe dinsurance dcarrier dto dverify dbenefits dand dpreauthorize dthe
dprocedure. dThe dcarrier dverifies dthe dpatient dhas da d$500 ddeductible dwhich dmust dbe
dmet. dAfter dthe ddeductible, dthe dPPO dwill dpay d80% dof dthe dclaim. dThe dcontracted
drate dfor dthe dprocedure dis d$2,500. dWhat dis dthe dpatient's dresponsibility?
A. d$400 d
B. d$500 d
C. d$900 d
D. d$1,600 d- dCORRECT✅✅C. d$900
,When da dnonparticipating dprovider dfiles da dclaim dfor da dpatient dto dBC/BS, dhow dis
dthe dpayment dprocessed? d
A. dThe dpayment dis dsent dto dthe dpatient dand dthe dpatient dmust dpay dthe dprovider. d
B. dThe dpayment dis dsent dto dthe dprovider dif dthe dprovider dagrees dto daccept
dassignment. d
C. dThe dpayment dis dsent dto dthe dprovider dregardless dif dhe daccepts dassignment. d
D. dThe dclaim dis dnot dpaid dbecause dthe dprovider dis dnot dparticipating din dthe dplan. d-
dCORRECT✅✅A. dThe dpayment dis dsent dto dthe dpatient dand dthe dpatient dmust dpay
dthe dprovider.
Which dof dthe dfollowing dTRICARE doptions dis/are davailable dto dactive dduty dservice
dmembers?
d
A. dTRICARE dSelect d
B. dTRICARE dPrime d
C. dTRICARE dFor dLife d
D. dTRICARE dYoung dAdult d- dCORRECT✅✅B. dTRICARE dPrime
A dMedicare dcard dwill dlist dwhich dof dthe dfollowing:
d
I. dEffective ddate dof dcoverage
II. dHome daddress
III. dTelephone dNumber
IV. dEntitled dto dPart dA dand/or dPart dB
V. dWhen dcoverage dends
VI. dName dof dPrimary dCare dPhysician
d
A. dI d- dVI d
B. dI, dIV d
C. dI-III, dVI d
D. dI, dII, dIV, dV d- dCORRECT✅✅B. dI, dIV
In dwhich dof dthe dfollowing dscenarios dis dMedicare dthe dsecondary dpayer?
I. dA d65 dyear-old dpatient dwho dis dcollecting dher ddeceased dspouse's dMedicare
dbenefits dand dhas da dsupplemental dinsurance
II. dA d72 dyear-old dpatient dwho dparticipates din dthe dgroup dhealth dinsurance dof dhis
demployer
III. dA d66 dyear-old dpatient dis dinjured dat dwork dand dthe demployer ddoes dnot doffer
dhealth dinsurance das da dbenefit dof demployment
IV. dA d55 dyear-old dpatient dwho dis don ddisability dthrough dSocial dSecurity dand
dqualifies dfor dMedicaid dand dMedicare d
A. dI-IV d
B. dII dand dIII d
C. dI dand dIV d
,D. dNone d- dCORRECT✅✅B. dII dand dIII
When da dpatient dhas dMedicare dprimary dand dAARP das dMedigap, dwhat dis dentered
don dthe dCMS-1500 dclaim dform din ditem d9d dfor dthe dInsurance dPlan dName dor
dProgram dName dfor dMedicare dto dcross dover dthe dclaim?
d
A. dPlan dname dfollowed dby d"MEDIGAP" d
B. dPlan dPayer dID dfollowed dby d"MEDIGAP" d
C. dCOBA dMedigap dclaim-based didentifier d(ID) d
D. dLeave dblank d- dCORRECT✅✅C. dCOBA dMedigap dclaim-based didentifier d(ID)
Which dguidelines dmust dall dbilling dpersonnel dbe dknowledgeable dabout din dorder dto
densure dcompliance dwith dMedicaid dprograms?
d
A. dFederal dguidelines d
B. dState dguidelines d
C. dBoth dA dand dB d
D. dNone d- dCORRECT✅✅C. dBoth dA dand dB
Which dof dthe dfollowing dservices dis dcovered dby dEarly dand dPeriodic dScreening,
dDiagnostic, dand dTreatment d(EPSDT)?
d
A. dFamily dplanning d
B. dObstetric dcare d
C. dPediatric dcheckups d
D. dEmergency ddepartment dvisits d- dCORRECT✅✅C. dPediatric dcheckups
A dfemale dpatient dwho dwas dinvolved din dan dauto daccident dpresents dto dthe
demergency ddepartment d(ED) dfor devaluation. dShe ddoes dnot dhave dany dcomplaints.
dThe dprovider devaluates dher dand ddetermines dthere dare dno dinjuries. dThe dprovider
dinforms dthe dpatient dto dcome dback dto dthe dED dor dsee dher dprimary dcare dphysician
dif dshe ddevelops dany dsymptoms. dHow dis dthe dclaim dprocessed dfor dthis dencounter? d
A. dThe dmedical dinsurance dis dbilled dprimary dand dthe dauto dinsurance dis dbilled
dsecondary. d
B. dThe dauto dinsurance dis dbilled dprimary dand dthe dmedical dinsurance dis dbilled
dsecondary. d
C. dBill dthe dmedical dinsurance dfirst dto dreceive da ddenial dand dthen dsubmit dwith dthe
dremittance dadvice dto dthe dauto dinsurance. d
D. dBill donly dthe dmedical dinsurance dbecause dthe dauto dinsurance donly dcovers
ddamage dto dthe dvehicle, dnot dmedical dexpenses. d- dCORRECT✅✅B. dThe dauto
dinsurance dis dbilled dprimary dand dthe dmedical dinsurance dis dbilled dsecondary.
What dforms dneed dto dbe dsubmitted dwhen dbilling dfor da dwork-related dinjury?
d
A. dProgress dreports, dand dWC-1500 dclaim dform d
B. dUB-04 d
C. dFirst dReport dof dInjury dform dand dan ditemized dstatement d
, D. dFirst dReport dof dInjury dform, dprogress dreports, dand dCMS-1500 dclaim dform d-
dCORRECT✅✅D. dFirst dReport dof dInjury dform, dprogress dreports, dand dCMS-1500
dclaim dform
A ddocument dprovided dto dMedicare dpatients dexplaining dtheir dfinancial dresponsibility
dif dMedicare ddenies da dservice dis da(n):
d
A. dNotice dof dFinancial dLiability d
B. dAdvance dBeneficiary dNotice d
C. dInsurance dwaiver d
D. dExplanation dof dBenefits d- dCORRECT✅✅B. dAdvance dBeneficiary dNotice
What dis dan dAccountable dCare dOrganization d(ACO)?
d
A. dGroups dof ddoctors, dhospitals, dand dother dhealth dcare dproviders dwho dcoordinate
dhigh dquality dcare dto dMedicare dpatients. d
B. dAn dinsurance dcarrier dthat dprovides da dset dfee dbased don dthe ddiagnosis dof dthe
dpatient. d
C. dA dgroup dof dproviders dwho dcontract dwith da dthird dparty dadministrator dto dpay dfee
dfor dservice dfor dservices. d
D. dHospitals dwho dsee da dsubset dof dpatients dfor dcost defficiency. d-
dCORRECT✅✅A. dGroups dof ddoctors, dhospitals, dand dother dhealth dcare dproviders
dwho dcoordinate dhigh dquality dcare dto dMedicare dpatients.
A dnew dpatient dpresents dfor dher dannual dexam dand dhas dno dcomplaints. dShe dis
dscheduled dto dsee dthe dphysician dassistant d(PA). dHow dshould dservices dbe dbilled d?
d
A. dBill dunder dthe dPA. d
B. dA dnew dpatient dcan dbe dbilled dincident dto dthe dphysician. d
C. dThe dPA dcannot dsee dnew dpatients. d
D. dReschedule dthe dpatient dwith dthe dphysician d- dCORRECT✅✅A. dBill dunder dthe
dPA.
CPT® dcodes d12032 dand d12001 dwere dreported dtogether dfor da d2.6 dcm dintermediate
drepair dof da dlaceration dto dthe dright darm dand da d2.5 dcm dsimple drepair dof da
dlaceration dto dthe dleft darm. d12001 dwas ddenied das da dbundled dservice. dWhat daction
dshould dbe dtaken dby dthe dbiller d(following dthe dCPT® dguidelines)?
d
A. dWrite-off dthe dcharge dfor d12001 das dit dis da dbundled dprocedure. d
B. dResubmit da dcorrected dclaim das d12032, d12001-59. d
C. dTransfer dthe dcharge dto dpatient dresponsibility. d
D. dResubmit da dcorrected dclaim das d12032, d12001-51. d- dCORRECT✅✅B.
dResubmit da dcorrected dclaim das d12032, d12001-59.
According dto dCMS, dwhich dof dthe dfollowing dservices dare dincluded din dthe dglobal
dpackage dfor dsurgical dprocedures?
I. dSurgical dprocedure dperformed
