AAPC CPB Practice Exam
i i i
JoeiandiMaryiareiaimarriedicoupleiandibothicarryiinsuranceifromitheiriemployers.iJoeiwasibornioniFebru
aryi23,i1977iandiMaryiwasibornioniAprili4,i1974.iUsingitheibirthdayirule,iwhoicarriesitheiprimaryiinsuran
ceiforitheirichildreniforibilling?
A.iJoe,ibecauseiheiisitheimaleiheadiofitheihousehold.i
B.iMary,ibecauseiheridateiofibirthiisithei4thiandiJoe'sidateiofibirthiisithei23rd.i
C.iMary,ibecauseiheribirthiyeariisibeforeiJoe'sibirthiyear.i
D.iJoe,ibecauseihisibirthimonthiandidayiareibeforeiMary'sibirthimonthiandiday.i-i
i ✅D.iJoe,ibecauseihisibirthimonthiandidayiareibeforeiMary'sibirthimonthiandiday.
Whichitypeiofimanagedicareiinsuranceiallowsipatientsitoiself-referitoiout-of-
networkiprovidersiandipayiaihigherico-insurance/copayiamount?i
I.iHMO
II.iPPO
III.iEPO
IV.iPOS
V.iCapitation
A.iIIi
B.iIVi
C.iIIiandiIVi
D.iII,iIII,iandiVi-i
i ✅C.iIIiandiIV
AipatienticoveredibyiaiPPOiisischedulediforikneeireplacementisurgery.iTheibillericontactsitheiinsuranceic
arrieritoiverifyibenefitsiandipreauthorizeitheiprocedure.iTheicarrieriverifiesitheipatientihasiai$500ideduc
tibleiwhichimustibeimet.iAfteritheideductible,itheiPPOiwillipayi80%iofitheiclaim.iTheicontractedirateiforit
heiprocedureiisi$2,500.iWhatiisitheipatient'siresponsibility?
1i|iP a g e
,A.i$400i
B.i$500i
C.i$900i
D.i$1,600i-i
i ✅C.i$900
WheniainonparticipatingiproviderifilesiaiclaimiforiaipatientitoiBC/BS,ihowiisitheipaymentiprocessed?i
A.iTheipaymentiisisentitoitheipatientianditheipatientimustipayitheiprovider.i
B.iTheipaymentiisisentitoitheiprovideriifitheiprovideriagreesitoiacceptiassignment.i
C.iTheipaymentiisisentitoitheiprovideriregardlessiifiheiacceptsiassignment.i
D.iTheiclaimiisinotipaidibecauseitheiprovideriisinotiparticipatingiinitheiplan.i-i
i ✅A.iTheipaymentiisisentitoitheipatientianditheipatientimustipayitheiprovider.
WhichiofitheifollowingiTRICAREioptionsiis/areiavailableitoiactiveidutyiserviceimembers?
i
A.iTRICAREiSelecti
B.iTRICAREiPrimei
C.iTRICAREiForiLifei
D.iTRICAREiYoungiAdulti-i
i ✅B.iTRICAREiPrime
AiMedicareicardiwillilistiwhichiofitheifollowing:
i
I.iEffectiveidateioficoverage
II.iHomeiaddress
III.iTelephoneiNumber
IV.iEntitleditoiPartiAiand/oriPartiB
V.iWhenicoverageiends
VI.iNameiofiPrimaryiCareiPhysician
i
A.iIi-iVIi
2i|iP a g e
,B.iI,iIVi
C.iI-III,iVIi
D.iI,iII,iIV,iVi-i
i ✅B.iI,iIV
IniwhichiofitheifollowingiscenariosiisiMedicareitheisecondaryipayer?
I.iAi65iyear-
oldipatientiwhoiisicollectingiherideceasedispouse'siMedicareibenefitsiandihasiaisupplementaliinsurance
II.iAi72iyear-oldipatientiwhoiparticipatesiinitheigroupihealthiinsuranceiofihisiemployer
III.iAi66iyear-
oldipatientiisiinjurediatiworkianditheiemployeridoesinotiofferihealthiinsuranceiasiaibenefitiofiemploymen
t
IV.iAi55iyear-
oldipatientiwhoiisionidisabilityithroughiSocialiSecurityiandiqualifiesiforiMedicaidiandiMedicarei
A.iI-IVi
B.iIIiandiIIIi
C.iIiandiIVi
D.iNonei-i
i ✅B.iIIiandiIII
WheniaipatientihasiMedicareiprimaryiandiAARPiasiMedigap,iwhatiisienteredionitheiCMS-
1500iclaimiformiiniitemi9diforitheiInsuranceiPlaniNameioriProgramiNameiforiMedicareitoicrossioveritheic
laim?
i
A.iPlaninameifollowedibyi"MEDIGAP"i
B.iPlaniPayeriIDifollowedibyi"MEDIGAP"i
C.iCOBAiMedigapiclaim-basediidentifieri(ID)i
D.iLeaveiblanki-i
i ✅C.iCOBAiMedigapiclaim-basediidentifieri(ID)
Whichiguidelinesimustiallibillingipersonnelibeiknowledgeableiaboutiiniorderitoiensureicomplianceiwithi
Medicaidiprograms?
3i|iP a g e
, i
A.iFederaliguidelinesi
B.iStateiguidelinesi
C.iBothiAiandiBi
D.iNonei-i
i ✅C.iBothiAiandiB
WhichiofitheifollowingiservicesiisicoveredibyiEarlyiandiPeriodiciScreening,iDiagnostic,iandiTreatmenti(EP
SDT)?
i
A.iFamilyiplanningi
B.iObstetricicarei
C.iPediatricicheckupsi
D.iEmergencyidepartmentivisitsi-i
i ✅C.iPediatricicheckups
Aifemaleipatientiwhoiwasiinvolvediinianiautoiaccidentipresentsitoitheiemergencyidepartmenti(ED)iforiev
aluation.iSheidoesinotihaveianyicomplaints.iTheiproviderievaluatesiheriandideterminesithereiareinoiinju
ries.iTheiprovideriinformsitheipatientitoicomeibackitoitheiEDioriseeiheriprimaryicareiphysicianiifisheidevel
opsianyisymptoms.iHowiisitheiclaimiprocessediforithisiencounter?i
A.iTheimedicaliinsuranceiisibillediprimaryianditheiautoiinsuranceiisibilledisecondary.i
B.iTheiautoiinsuranceiisibillediprimaryianditheimedicaliinsuranceiisibilledisecondary.i
C.iBillitheimedicaliinsuranceifirstitoireceiveiaidenialiandithenisubmitiwithitheiremittanceiadviceitoitheiaut
oiinsurance.i
D.iBillionlyitheimedicaliinsuranceibecauseitheiautoiinsuranceionlyicoversidamageitoitheivehicle,inotimedi
caliexpenses.i-i
i ✅B.iTheiautoiinsuranceiisibillediprimaryianditheimedicaliinsuranceiisibilledisecondary.
Whatiformsineeditoibeisubmittediwhenibillingiforiaiwork-relatediinjury?
i
A.iProgressireports,iandiWC-1500iclaimiformi
B.iUB-04i
C.iFirstiReportiofiInjuryiformiandianiitemizedistatementi
4i|iP a g e
i i i
JoeiandiMaryiareiaimarriedicoupleiandibothicarryiinsuranceifromitheiriemployers.iJoeiwasibornioniFebru
aryi23,i1977iandiMaryiwasibornioniAprili4,i1974.iUsingitheibirthdayirule,iwhoicarriesitheiprimaryiinsuran
ceiforitheirichildreniforibilling?
A.iJoe,ibecauseiheiisitheimaleiheadiofitheihousehold.i
B.iMary,ibecauseiheridateiofibirthiisithei4thiandiJoe'sidateiofibirthiisithei23rd.i
C.iMary,ibecauseiheribirthiyeariisibeforeiJoe'sibirthiyear.i
D.iJoe,ibecauseihisibirthimonthiandidayiareibeforeiMary'sibirthimonthiandiday.i-i
i ✅D.iJoe,ibecauseihisibirthimonthiandidayiareibeforeiMary'sibirthimonthiandiday.
Whichitypeiofimanagedicareiinsuranceiallowsipatientsitoiself-referitoiout-of-
networkiprovidersiandipayiaihigherico-insurance/copayiamount?i
I.iHMO
II.iPPO
III.iEPO
IV.iPOS
V.iCapitation
A.iIIi
B.iIVi
C.iIIiandiIVi
D.iII,iIII,iandiVi-i
i ✅C.iIIiandiIV
AipatienticoveredibyiaiPPOiisischedulediforikneeireplacementisurgery.iTheibillericontactsitheiinsuranceic
arrieritoiverifyibenefitsiandipreauthorizeitheiprocedure.iTheicarrieriverifiesitheipatientihasiai$500ideduc
tibleiwhichimustibeimet.iAfteritheideductible,itheiPPOiwillipayi80%iofitheiclaim.iTheicontractedirateiforit
heiprocedureiisi$2,500.iWhatiisitheipatient'siresponsibility?
1i|iP a g e
,A.i$400i
B.i$500i
C.i$900i
D.i$1,600i-i
i ✅C.i$900
WheniainonparticipatingiproviderifilesiaiclaimiforiaipatientitoiBC/BS,ihowiisitheipaymentiprocessed?i
A.iTheipaymentiisisentitoitheipatientianditheipatientimustipayitheiprovider.i
B.iTheipaymentiisisentitoitheiprovideriifitheiprovideriagreesitoiacceptiassignment.i
C.iTheipaymentiisisentitoitheiprovideriregardlessiifiheiacceptsiassignment.i
D.iTheiclaimiisinotipaidibecauseitheiprovideriisinotiparticipatingiinitheiplan.i-i
i ✅A.iTheipaymentiisisentitoitheipatientianditheipatientimustipayitheiprovider.
WhichiofitheifollowingiTRICAREioptionsiis/areiavailableitoiactiveidutyiserviceimembers?
i
A.iTRICAREiSelecti
B.iTRICAREiPrimei
C.iTRICAREiForiLifei
D.iTRICAREiYoungiAdulti-i
i ✅B.iTRICAREiPrime
AiMedicareicardiwillilistiwhichiofitheifollowing:
i
I.iEffectiveidateioficoverage
II.iHomeiaddress
III.iTelephoneiNumber
IV.iEntitleditoiPartiAiand/oriPartiB
V.iWhenicoverageiends
VI.iNameiofiPrimaryiCareiPhysician
i
A.iIi-iVIi
2i|iP a g e
,B.iI,iIVi
C.iI-III,iVIi
D.iI,iII,iIV,iVi-i
i ✅B.iI,iIV
IniwhichiofitheifollowingiscenariosiisiMedicareitheisecondaryipayer?
I.iAi65iyear-
oldipatientiwhoiisicollectingiherideceasedispouse'siMedicareibenefitsiandihasiaisupplementaliinsurance
II.iAi72iyear-oldipatientiwhoiparticipatesiinitheigroupihealthiinsuranceiofihisiemployer
III.iAi66iyear-
oldipatientiisiinjurediatiworkianditheiemployeridoesinotiofferihealthiinsuranceiasiaibenefitiofiemploymen
t
IV.iAi55iyear-
oldipatientiwhoiisionidisabilityithroughiSocialiSecurityiandiqualifiesiforiMedicaidiandiMedicarei
A.iI-IVi
B.iIIiandiIIIi
C.iIiandiIVi
D.iNonei-i
i ✅B.iIIiandiIII
WheniaipatientihasiMedicareiprimaryiandiAARPiasiMedigap,iwhatiisienteredionitheiCMS-
1500iclaimiformiiniitemi9diforitheiInsuranceiPlaniNameioriProgramiNameiforiMedicareitoicrossioveritheic
laim?
i
A.iPlaninameifollowedibyi"MEDIGAP"i
B.iPlaniPayeriIDifollowedibyi"MEDIGAP"i
C.iCOBAiMedigapiclaim-basediidentifieri(ID)i
D.iLeaveiblanki-i
i ✅C.iCOBAiMedigapiclaim-basediidentifieri(ID)
Whichiguidelinesimustiallibillingipersonnelibeiknowledgeableiaboutiiniorderitoiensureicomplianceiwithi
Medicaidiprograms?
3i|iP a g e
, i
A.iFederaliguidelinesi
B.iStateiguidelinesi
C.iBothiAiandiBi
D.iNonei-i
i ✅C.iBothiAiandiB
WhichiofitheifollowingiservicesiisicoveredibyiEarlyiandiPeriodiciScreening,iDiagnostic,iandiTreatmenti(EP
SDT)?
i
A.iFamilyiplanningi
B.iObstetricicarei
C.iPediatricicheckupsi
D.iEmergencyidepartmentivisitsi-i
i ✅C.iPediatricicheckups
Aifemaleipatientiwhoiwasiinvolvediinianiautoiaccidentipresentsitoitheiemergencyidepartmenti(ED)iforiev
aluation.iSheidoesinotihaveianyicomplaints.iTheiproviderievaluatesiheriandideterminesithereiareinoiinju
ries.iTheiprovideriinformsitheipatientitoicomeibackitoitheiEDioriseeiheriprimaryicareiphysicianiifisheidevel
opsianyisymptoms.iHowiisitheiclaimiprocessediforithisiencounter?i
A.iTheimedicaliinsuranceiisibillediprimaryianditheiautoiinsuranceiisibilledisecondary.i
B.iTheiautoiinsuranceiisibillediprimaryianditheimedicaliinsuranceiisibilledisecondary.i
C.iBillitheimedicaliinsuranceifirstitoireceiveiaidenialiandithenisubmitiwithitheiremittanceiadviceitoitheiaut
oiinsurance.i
D.iBillionlyitheimedicaliinsuranceibecauseitheiautoiinsuranceionlyicoversidamageitoitheivehicle,inotimedi
caliexpenses.i-i
i ✅B.iTheiautoiinsuranceiisibillediprimaryianditheimedicaliinsuranceiisibilledisecondary.
Whatiformsineeditoibeisubmittediwhenibillingiforiaiwork-relatediinjury?
i
A.iProgressireports,iandiWC-1500iclaimiformi
B.iUB-04i
C.iFirstiReportiofiInjuryiformiandianiitemizedistatementi
4i|iP a g e
