AAPC CPB - Practice Exam A – UPDATED Questions with 100% Verified Answers
AAPC CPB - Practice Exam A – UPDATED
Questions with 100% Verified Answers
Section 1: Insurance, Patient, Provider (Q1–Q11)
Question & Answer
Q1 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.
A D. Joe, because his birth month and day are before Mary's birth month and day.
Q2 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
A C. II and IV
Q3 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
A C. $900
Q4 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.
A A. The payment is sent to the patient and the patient must pay the provider.
Page 1 of 14
, AAPC CPB - Practice Exam A – UPDATED Questions with 100% Verified Answers
Question & Answer
Q5 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
A B. TRICARE Prime
Q6 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
A B. I, IV
Q7 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
A B. II and III
Q8 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
A C. COBA Medigap claim-based identifier (ID)
Q9 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
D. None
A C. Both A and B
Page 2 of 14
AAPC CPB - Practice Exam A – UPDATED
Questions with 100% Verified Answers
Section 1: Insurance, Patient, Provider (Q1–Q11)
Question & Answer
Q1 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.
A D. Joe, because his birth month and day are before Mary's birth month and day.
Q2 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
A C. II and IV
Q3 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
A C. $900
Q4 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.
A A. The payment is sent to the patient and the patient must pay the provider.
Page 1 of 14
, AAPC CPB - Practice Exam A – UPDATED Questions with 100% Verified Answers
Question & Answer
Q5 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
A B. TRICARE Prime
Q6 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
A B. I, IV
Q7 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
A B. II and III
Q8 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
A C. COBA Medigap claim-based identifier (ID)
Q9 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
D. None
A C. Both A and B
Page 2 of 14
