AAPC CPB - Chapter 2 Review/ Questions with
Certified Solutions.
A new physician comes into the practice that is just out of medical school. He will need to be
able to see patients in the office and at the hospital. What process will he need to undergo in
order to be able to participate with Medicare and other health plans?
a. Credentialing
b. Privileging
c. Contract negotiations
d. Board certification - Answer: a. Credentialing
The following is a capitation schedule for a pediatric practice.
Member's Age Capitation per Member, per Month
0-1 $25.00
2-4 $10.00
5-20 $5.00
Page 1 of 9
, The practice has 300 members age 0-1, 500 members age 2-4, and 2000 members age 5-20 that
stay with the practice for an entire year. If the practice also performs "carve-out" services worth
$20,000, how much money will they earn over the course of a year?
a. 270,000
b. 250,000
c. 290,000
d. 300,000 - Answer: c. 290,000
A patient needs to see a specialist for a cardiac condition. She references her insurance
handbook for a list of network providers that belong to that specialty. She may choose any
physician she wishes and does not need a referral from her Internist to see the specialist. If she
chooses an out-of-network physician, she will have to pay a higher co-insurance amount to see
them. What type of insurance does this patient have?
a. HMO
b. PPO
c. Medicare
d. Medicaid - Answer: b. PPO
NPI is an abbreviation for a unique number that is required by HIPAA. What does NPI stand for?
a. National Physician Identifier
b. National Provider Insurance
c. National Provider Identifier
d. National Participating Identifier - Answer: c. National Provider Identifier
Page 2 of 9
Certified Solutions.
A new physician comes into the practice that is just out of medical school. He will need to be
able to see patients in the office and at the hospital. What process will he need to undergo in
order to be able to participate with Medicare and other health plans?
a. Credentialing
b. Privileging
c. Contract negotiations
d. Board certification - Answer: a. Credentialing
The following is a capitation schedule for a pediatric practice.
Member's Age Capitation per Member, per Month
0-1 $25.00
2-4 $10.00
5-20 $5.00
Page 1 of 9
, The practice has 300 members age 0-1, 500 members age 2-4, and 2000 members age 5-20 that
stay with the practice for an entire year. If the practice also performs "carve-out" services worth
$20,000, how much money will they earn over the course of a year?
a. 270,000
b. 250,000
c. 290,000
d. 300,000 - Answer: c. 290,000
A patient needs to see a specialist for a cardiac condition. She references her insurance
handbook for a list of network providers that belong to that specialty. She may choose any
physician she wishes and does not need a referral from her Internist to see the specialist. If she
chooses an out-of-network physician, she will have to pay a higher co-insurance amount to see
them. What type of insurance does this patient have?
a. HMO
b. PPO
c. Medicare
d. Medicaid - Answer: b. PPO
NPI is an abbreviation for a unique number that is required by HIPAA. What does NPI stand for?
a. National Physician Identifier
b. National Provider Insurance
c. National Provider Identifier
d. National Participating Identifier - Answer: c. National Provider Identifier
Page 2 of 9
