AAPC CPB Practice Exam Questions
With 100% Verified Answers
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. -
correct 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
II. PPO
III. EPO
IV. POS
,AAPC CPB Practice Exam Questions
With 100% Verified Answers
V. Capitation
A. II
B. IV
C. II and IV
D. II, III, and V -
correct 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
C. $900
D. $1,600 -
correct answer ✅C. $900
,AAPC CPB Practice Exam Questions
With 100% Verified Answers
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. -
correct 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
D. TRICARE Young Adult -
correct answer ✅B. TRICARE Prime
, AAPC CPB Practice Exam Questions
With 100% Verified Answers
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 -
correct answer ✅B. I, IV
In which of the following scenarios is Medicare the secondary
payer?
I. A 65 year-old patient who is collecting her deceased spouse's
Medicare benefits and has a supplemental insurance
With 100% Verified Answers
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. -
correct 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
II. PPO
III. EPO
IV. POS
,AAPC CPB Practice Exam Questions
With 100% Verified Answers
V. Capitation
A. II
B. IV
C. II and IV
D. II, III, and V -
correct 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
C. $900
D. $1,600 -
correct answer ✅C. $900
,AAPC CPB Practice Exam Questions
With 100% Verified Answers
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. -
correct 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
D. TRICARE Young Adult -
correct answer ✅B. TRICARE Prime
, AAPC CPB Practice Exam Questions
With 100% Verified Answers
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 -
correct answer ✅B. I, IV
In which of the following scenarios is Medicare the secondary
payer?
I. A 65 year-old patient who is collecting her deceased spouse's
Medicare benefits and has a supplemental insurance
