AAPC CPB - PRACTICE EXAM B QUESTIONS AND ANSWERS WITH SOLUTIONS 2024

AAPC CPB - PRACTICE EXAM B
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
What is the term for the total amount of covered medical expenses a policyholder must pay each year o
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ut-of-pocket before the health insurance company begins to pay any benefits?
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A. Copayment
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B. Deductible
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C. Secondary Payment
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D. Coinsurance - ANSWER B. Deductible
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Which type of insurance covers physicians and other healthcare professionals for liability as to claims ari
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sing from patient treatment?
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A. Business liability
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B. Bonding
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C. Medical malpractice
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D. Workers' compensation - ANSWER C. Medical malpractice
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Which of the following does NOT fall under group policy insurance?
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I. The premium is paid for by the employee.
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II. The premium is paid for (or partially paid for) by an employer.
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III. The employer selects the plan(s) to offer to employees.
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IV. Physical exams and medical history questionnaires are a mandatory part of the application process.
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V. Employee can make changes to the policy.
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VI. The employee's spouse and children are not eligible for coverage.
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A. III, IV, and V
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B. II, III, and VI
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, C. II, IV, and V
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D. I, IV, V, and VI - ANSWER D. I, IV, V, and VI
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Dr. Wallace is in a capitation contract with Belleview Managed Care Health Plan. He received $25,000 fr
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om the health plan to provide services for the 175 enrollees on the health plan. The services provided b
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y Dr. Wallace to the enrollees cost $23,000. Based on the information, what must be done?
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A. Dr. Wallace can keep the $2,000 profit under the terms of the capitated plan.
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B. Dr. Wallace experienced a loss under the capitated plan and will need to pay $2,000 to the health pla
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C. Dr. Wallace will need to payout the $2,000 to the 175 enrollees.
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D. Dr. Wallace is required to put the $2,000 in a mutual fund. -
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ANSWER A. Dr. Wallace can keep the $2,000 profit under the terms of the capitated plan.
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What is the deadline for filing a Medicare claim?
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A. One year from the date of service
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B. 30 days from the date of service
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C. 90 days from the date of service
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D. Two years from the date of service - ANSWER A. One year from the date of service
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A provider sees a patient who has TRICARE Select. The provider is not contracted with TRICARE but is ce
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rtified by the regional TRICARE Managed Care Support Contractor (MCSC). The provider charges $200 fo
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r the office visit. TRICARE allows $160 and pays $140. How much can the provider bill the patient for?
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A. $0.00Q Q




B. $20.00
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C. $60.00
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D. $160.00 - ANSWER C. $60.00
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What organization is responsible in evaluating the medical necessity, appropriateness, and efficiency of t
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he use of healthcare services and procedures?
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