CPB Practice Exam – Complete Questions and Correct Answers for
Certified Professional Biller (AAPC) Exam Preparation
who is covered by champva?
a) veterans with service - connected disabilities and their families
b) active duty military and their families
c) retired military and their families
d) active duty military over the age of 65 - correct answer a) veterans with service - connected
disabilities and their families
rationale: the civilian health and medical program of the department of veterans affairs
(champva) covers veterans who are permanently and totally disabled due to a service-related
disability and their spouse and children.
patient is brought to the local urgent care after falling from a ladder while hanging exterior
lights on his house. x-rays revealed a closed fracture of his left femur. the patient is covered by
his employer's group health plan and he also has a homeowner's liability insurance policy.
which insurance should be billed?
a) the homeowner's insurance first, followed by the group health plan
b) the employer's group health plan
c) the homeowner's insurance only
d) file the employer's group health plan as primary and list the homeowner's insurance as
secondary. - correct answer b) the employer's group health plan
rationale: the health insurance plan is billed first and then through the process of subrogation it
will be determined if a liability payer should be considered primary.
3. private companies contract with cms to administer:
a) medicare part a & b
b) medicare part b
,c) medicare part c
d) medicare part a, b, & c - correct answer d) medicare part a, b, and c
rationale: medicare part a, b, and c are all administered by private companies that contract
with cms as medicare administrative contractors or macs.
what is a co-payment?
a) an amount paid every month by the policyholder to maintain health insurance coverage
b) a percentage of the allowed amount that the patient is responsible for.
c) a flat amount paid to the healthcare provider when the policyholder is seen for an office visit.
d) the adjusted amount based on the insurance policy requirement. - correct answer c) a flat
amount paid to the healthcare provider when the policy holder is seen for an office visit.
which of the following statements is true regarding the non-par medicare allowed fee
schedule?
a) the non-par provider can bill the patient the difference between the charge and the
medicare allowable.
b) the non-par limiting charge is 115% of the non-par medicare physician fee schedule
c) the non-par physician fee schedule is 115% of the par medicare physician fee schedule
d) the non-par limiting charge is 95% of the par medicare physician fee schedule. - correct
answer b) the non-par limiting charge is 115% of the non-par medicare physician fee schedule.
rationale: per cms, the non-par limiting charge is 115% of the non-par medicare physician fee
schedule.
what is a medigap policy?
a) a policy that covers healthcare services that medicare does not cover.
b) a policy that will not reimburse for out-of-pocket costs not covered by medicare
c) a supplemental insurance offered by cms.
, d) a policy required by medicare. - correct answer a) a policy that covers healthcare services
that medicare does not cover.
medicare part a is available to individuals under the age of 65 who have:
a) diabetes mellitus type i or ii
b) ckd (chronic kidney disease)
c) esrd and meet certain requirements
d) any chronic health condition - correct answer c) esrd and meet certain requirements.
rationale: medicare part a coverage is available to individuals below the age of 65 who have; 1)
received social security or rrb disability benefits for 24 months, 2) end-stage renal disease and
meet certain requirements
which of the following statements is true regarding medicaid?
a) medicaid eligibility policies are the same for states of similar size and geographic region.
b) medicaid eligibility is clear and consistent from state to state
c) medicaid programs receive matching ffederal funding only if certain healthcare services are
provided to eligible individuals.
d) medicaid programs must provide medical assistance for all poor persons. - correct answer c)
medicaid programs receive matching federal funding only if certain healthcare services are
provided to eligble individuals.
medicaid programs must provide certain healthcare services to eligible individuals in order to
receive matching federal funds known as federal medical assistance percentage (fmap). the
percentage is determined on a year to year basis using a formula that compares the state's per
capita average income with the national average. states with lower average income per capita
receive a higher fmap.
when submitting a medigap policy, which option is an example of how the patient's id number
should appear in item 9a of the cms-1500 claim form?
a) 123456789
Certified Professional Biller (AAPC) Exam Preparation
who is covered by champva?
a) veterans with service - connected disabilities and their families
b) active duty military and their families
c) retired military and their families
d) active duty military over the age of 65 - correct answer a) veterans with service - connected
disabilities and their families
rationale: the civilian health and medical program of the department of veterans affairs
(champva) covers veterans who are permanently and totally disabled due to a service-related
disability and their spouse and children.
patient is brought to the local urgent care after falling from a ladder while hanging exterior
lights on his house. x-rays revealed a closed fracture of his left femur. the patient is covered by
his employer's group health plan and he also has a homeowner's liability insurance policy.
which insurance should be billed?
a) the homeowner's insurance first, followed by the group health plan
b) the employer's group health plan
c) the homeowner's insurance only
d) file the employer's group health plan as primary and list the homeowner's insurance as
secondary. - correct answer b) the employer's group health plan
rationale: the health insurance plan is billed first and then through the process of subrogation it
will be determined if a liability payer should be considered primary.
3. private companies contract with cms to administer:
a) medicare part a & b
b) medicare part b
,c) medicare part c
d) medicare part a, b, & c - correct answer d) medicare part a, b, and c
rationale: medicare part a, b, and c are all administered by private companies that contract
with cms as medicare administrative contractors or macs.
what is a co-payment?
a) an amount paid every month by the policyholder to maintain health insurance coverage
b) a percentage of the allowed amount that the patient is responsible for.
c) a flat amount paid to the healthcare provider when the policyholder is seen for an office visit.
d) the adjusted amount based on the insurance policy requirement. - correct answer c) a flat
amount paid to the healthcare provider when the policy holder is seen for an office visit.
which of the following statements is true regarding the non-par medicare allowed fee
schedule?
a) the non-par provider can bill the patient the difference between the charge and the
medicare allowable.
b) the non-par limiting charge is 115% of the non-par medicare physician fee schedule
c) the non-par physician fee schedule is 115% of the par medicare physician fee schedule
d) the non-par limiting charge is 95% of the par medicare physician fee schedule. - correct
answer b) the non-par limiting charge is 115% of the non-par medicare physician fee schedule.
rationale: per cms, the non-par limiting charge is 115% of the non-par medicare physician fee
schedule.
what is a medigap policy?
a) a policy that covers healthcare services that medicare does not cover.
b) a policy that will not reimburse for out-of-pocket costs not covered by medicare
c) a supplemental insurance offered by cms.
, d) a policy required by medicare. - correct answer a) a policy that covers healthcare services
that medicare does not cover.
medicare part a is available to individuals under the age of 65 who have:
a) diabetes mellitus type i or ii
b) ckd (chronic kidney disease)
c) esrd and meet certain requirements
d) any chronic health condition - correct answer c) esrd and meet certain requirements.
rationale: medicare part a coverage is available to individuals below the age of 65 who have; 1)
received social security or rrb disability benefits for 24 months, 2) end-stage renal disease and
meet certain requirements
which of the following statements is true regarding medicaid?
a) medicaid eligibility policies are the same for states of similar size and geographic region.
b) medicaid eligibility is clear and consistent from state to state
c) medicaid programs receive matching ffederal funding only if certain healthcare services are
provided to eligible individuals.
d) medicaid programs must provide medical assistance for all poor persons. - correct answer c)
medicaid programs receive matching federal funding only if certain healthcare services are
provided to eligble individuals.
medicaid programs must provide certain healthcare services to eligible individuals in order to
receive matching federal funds known as federal medical assistance percentage (fmap). the
percentage is determined on a year to year basis using a formula that compares the state's per
capita average income with the national average. states with lower average income per capita
receive a higher fmap.
when submitting a medigap policy, which option is an example of how the patient's id number
should appear in item 9a of the cms-1500 claim form?
a) 123456789
