©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
AAPC CPB Practice Exam Questions and
Answers (100% Pass)
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
1
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
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
2
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
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
3
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
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?
4
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
AAPC CPB Practice Exam Questions and
Answers (100% Pass)
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
1
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
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
2
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
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
3
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
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?
4
