AAPC CPB FINAL 2027 ANSWERS AND QUESTIONS
SET A+
✔✔Beth has purchased a Medigap policy to supplement her Medicare coverage. She
has authorized Medicare to send payments directly to the physician, and Medicare has
transferred their claims information to the Medigap insurance company. This transfer of
information is known as: - ✔✔cross over
✔✔Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a program
associated with - ✔✔Medicaid
✔✔Which of the following are mandatory benefits that must be provided by Medicaid
programs in order to receive matching federal funding. - ✔✔outpt, home, inpt, fed qual
health services
✔✔agree to accept the fee schedules determined by the insurance company. -
✔✔participating providers
✔✔Blue Cross/Blue Shield identifies the individual who is eligible for covered services
as the: - ✔✔member
✔✔Jared is employed with the United States Internal Revenue Service and has enrolled
in the Blue Cross/Blue Shield healthcare insurance offered through this employer. What
is the name of the Blue Cross/Blue Shield insurance program offered by the federal
government? - ✔✔FEP (Federal Employee Program)
✔✔The process of reviewing and validating professional qualifications of healthcare
providers applying to participate with an organization is known as: - ✔✔credentialing
✔✔Carl has enrolled in a healthcare insurance plan that allows him to choose to have
services provided within the Blue Cross/Blue Shield network or outside of the network.
What type of plan best describes Carl's insurance coverage? - ✔✔pt of service
, ✔✔Not allowed under a participating provider's contract. - ✔✔balance billing
✔✔A savings account that allows individuals to save pre-tax dollars to reimburse for
healthcare expenses is known as a(n): - ✔✔FSA, HSA
✔✔Obtaining approval from the insurance payer before a procedure is performed is
known as: - ✔✔prior auth
✔✔timely filing restrictions are determined by: - ✔✔payer
✔✔Blue Cross/Blue Shield identifies the individual or employer who pays for healthcare
insurance coverage as the: - ✔✔subscriber
✔✔If a claim is denied, investigated, and found to be denied in error, what should a
biller do? - ✔✔appeal
✔✔An initial denial is received in the office from Aetna. The denial is investigated and
the office considers that the payment was not according to their contract. According to
Aetna's policy, what must the biller do? - ✔✔submit a reconsideration
✔✔Under what Federal Act must insurance companies implement effective to appeals
processes? - ✔✔pt protection and affordable care act
✔✔Which of the following can be appealed regarding a claim? - ✔✔coordination of
benefits
✔✔According to Cigna's appeals process, how many level of internal appeals are
offered? - ✔✔11
✔✔According to Aetna's published guidelines, what is the timeframe for filing an
appeal? - ✔✔60 days
✔✔A patient is involved in an accident at work and their commercial insurance is billed.
What type of denial will be received? - ✔✔liability issue
✔✔When the Cigna appeals process has been exhausted, what happens if the provider
still disagrees with the decision? - ✔✔arbitration
✔✔An initial denial is received in the office from Aetna. The denial is investigated and
the office considers that the payment was not according to their contract. According to
Aetna's policy, what must the biller do? - ✔✔submit reconsideration
SET A+
✔✔Beth has purchased a Medigap policy to supplement her Medicare coverage. She
has authorized Medicare to send payments directly to the physician, and Medicare has
transferred their claims information to the Medigap insurance company. This transfer of
information is known as: - ✔✔cross over
✔✔Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a program
associated with - ✔✔Medicaid
✔✔Which of the following are mandatory benefits that must be provided by Medicaid
programs in order to receive matching federal funding. - ✔✔outpt, home, inpt, fed qual
health services
✔✔agree to accept the fee schedules determined by the insurance company. -
✔✔participating providers
✔✔Blue Cross/Blue Shield identifies the individual who is eligible for covered services
as the: - ✔✔member
✔✔Jared is employed with the United States Internal Revenue Service and has enrolled
in the Blue Cross/Blue Shield healthcare insurance offered through this employer. What
is the name of the Blue Cross/Blue Shield insurance program offered by the federal
government? - ✔✔FEP (Federal Employee Program)
✔✔The process of reviewing and validating professional qualifications of healthcare
providers applying to participate with an organization is known as: - ✔✔credentialing
✔✔Carl has enrolled in a healthcare insurance plan that allows him to choose to have
services provided within the Blue Cross/Blue Shield network or outside of the network.
What type of plan best describes Carl's insurance coverage? - ✔✔pt of service
, ✔✔Not allowed under a participating provider's contract. - ✔✔balance billing
✔✔A savings account that allows individuals to save pre-tax dollars to reimburse for
healthcare expenses is known as a(n): - ✔✔FSA, HSA
✔✔Obtaining approval from the insurance payer before a procedure is performed is
known as: - ✔✔prior auth
✔✔timely filing restrictions are determined by: - ✔✔payer
✔✔Blue Cross/Blue Shield identifies the individual or employer who pays for healthcare
insurance coverage as the: - ✔✔subscriber
✔✔If a claim is denied, investigated, and found to be denied in error, what should a
biller do? - ✔✔appeal
✔✔An initial denial is received in the office from Aetna. The denial is investigated and
the office considers that the payment was not according to their contract. According to
Aetna's policy, what must the biller do? - ✔✔submit a reconsideration
✔✔Under what Federal Act must insurance companies implement effective to appeals
processes? - ✔✔pt protection and affordable care act
✔✔Which of the following can be appealed regarding a claim? - ✔✔coordination of
benefits
✔✔According to Cigna's appeals process, how many level of internal appeals are
offered? - ✔✔11
✔✔According to Aetna's published guidelines, what is the timeframe for filing an
appeal? - ✔✔60 days
✔✔A patient is involved in an accident at work and their commercial insurance is billed.
What type of denial will be received? - ✔✔liability issue
✔✔When the Cigna appeals process has been exhausted, what happens if the provider
still disagrees with the decision? - ✔✔arbitration
✔✔An initial denial is received in the office from Aetna. The denial is investigated and
the office considers that the payment was not according to their contract. According to
Aetna's policy, what must the biller do? - ✔✔submit reconsideration
