CPB PRACTICE EXAM A QUESTIONS
& ANSWERS(RATED 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 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. - ANSWERD. 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 - ANSWERPoint-of-Service Plan (POS) and Preferred Provider
Organization (PPO) allow patients the flexibility to self-refer to a specialist instead of
requiring a referral from a primary care provider. A patient is required to pay a higher
deductible, co-insurance or co-payment amount when he/she sees an out-of-network
provider
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. $400B. $500C. $900D. $1,600 - ANSWERThe contracted rate is $2500. The patient
must pay the deductible ($500) and 20% of $2,000 ($400). The total patient
responsibility is $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. - ANSWEREven when
nonparticipating providers with BC/BS agree to submit the claim for the patient or
accept assignment, BC/BS sends the payment to the patient. The patient is responsible
for paying the provider.
Which of the following TRICARE options is/are available to active duty service
members?
A. TRICARE SelectB. TRICARE PrimeC. TRICARE For LifeD. TRICARE Young Adult -
ANSWERB
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 - VIB. I, IVC. I-III, VID. I, II, IV, V - ANSWERB
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 insuranceII. A 72 year-old patient who participates in the group health
insurance of his employerIII. A 66 year-old patient is injured at work and the employer
does not offer health insurance as a benefit of employmentIV. A 55 year-old patient who
is on disability through Social Security and qualifies for Medicaid and Medicare
A. I-IVB. II and IIIC. I and IVD. None - ANSWERB
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*From the
Medicare Claims Processing Manual, Chapter 26 & Chapter 28 "Item 9d -Enter the 9-
digit PAYERID number of the Medigap insurer. If no PAYERID number exists, then
enter the Medigap insurance program or plan name.If the beneficiary wants Medicare
payment data forwarded to a Medigap insurer through the Medigap claim-based
crossover process, the participating provider of service or supplier must accurately
complete all of the information in items 9, 9a, 9b, and 9d.A Medicare participating
provider or supplier shall only enter the COBA Medigap claim-based ID within item 9d
when seeking to have the beneficiary's claim crossed over to a Medigap insurer. If a
participating provider or supplier enters the PAYERID or the Medigap insurer program
or its plan name within item 9d, the Medicare Part B contractor or Durable Medical
Equipment Medicare Administrative Contractor (DMAC) will be unable to forward the
claim information to the Medigap insurer prior to October 1, 2007, or to the Coordination
& ANSWERS(RATED 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 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. - ANSWERD. 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 - ANSWERPoint-of-Service Plan (POS) and Preferred Provider
Organization (PPO) allow patients the flexibility to self-refer to a specialist instead of
requiring a referral from a primary care provider. A patient is required to pay a higher
deductible, co-insurance or co-payment amount when he/she sees an out-of-network
provider
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. $400B. $500C. $900D. $1,600 - ANSWERThe contracted rate is $2500. The patient
must pay the deductible ($500) and 20% of $2,000 ($400). The total patient
responsibility is $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. - ANSWEREven when
nonparticipating providers with BC/BS agree to submit the claim for the patient or
accept assignment, BC/BS sends the payment to the patient. The patient is responsible
for paying the provider.
Which of the following TRICARE options is/are available to active duty service
members?
A. TRICARE SelectB. TRICARE PrimeC. TRICARE For LifeD. TRICARE Young Adult -
ANSWERB
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 - VIB. I, IVC. I-III, VID. I, II, IV, V - ANSWERB
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 insuranceII. A 72 year-old patient who participates in the group health
insurance of his employerIII. A 66 year-old patient is injured at work and the employer
does not offer health insurance as a benefit of employmentIV. A 55 year-old patient who
is on disability through Social Security and qualifies for Medicaid and Medicare
A. I-IVB. II and IIIC. I and IVD. None - ANSWERB
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*From the
Medicare Claims Processing Manual, Chapter 26 & Chapter 28 "Item 9d -Enter the 9-
digit PAYERID number of the Medigap insurer. If no PAYERID number exists, then
enter the Medigap insurance program or plan name.If the beneficiary wants Medicare
payment data forwarded to a Medigap insurer through the Medigap claim-based
crossover process, the participating provider of service or supplier must accurately
complete all of the information in items 9, 9a, 9b, and 9d.A Medicare participating
provider or supplier shall only enter the COBA Medigap claim-based ID within item 9d
when seeking to have the beneficiary's claim crossed over to a Medigap insurer. If a
participating provider or supplier enters the PAYERID or the Medigap insurer program
or its plan name within item 9d, the Medicare Part B contractor or Durable Medical
Equipment Medicare Administrative Contractor (DMAC) will be unable to forward the
claim information to the Medigap insurer prior to October 1, 2007, or to the Coordination
