AAPC CPB CHAPTER 12 FINAL PAPER 2026
COMPLETE QUESTIONS WITH SOLUTIONS
GRADED A+
◉ A patient has Medicare and a Medigap policy. Box 13, signature on
file, is checked off on the electronic claim submission. An EOMB is
received with remittance notice MA19. What does the office need to
do?
a. Nothing. This means the claim has been crossed over to the
Medigap plan.
b. The biller must file the secondary insurance as the cross-over
claim is not going to be sent due to missing information.
c. The biller must check the claim filed for missing information, add
the missing information, and send back to Medicare for processing.
d. Nothing. The notice means that the patient is responsible for the
bill.. Answer: b. The biller must file the secondary insurance as the
cross-over claim is not going to be sent due to missing information.
◉ A Medicare patient receives services from a participating provider
on January 6, 2016, but the charges are missed and don't get entered
in to the computer. How long does the office have to bill Medicare for
the services?
,a. 3 months
b. 12 months
c. 6 months
d. 1 month. Answer: b. 12 months
◉ What is true regarding Medigap policies?
a. They cover everything that Medicare does not.
b. They cover deductibles, copayments, and coinsurances usually.
c. All Medigap policies are the same and offer the same coverage.
d. Medigap policies must cover patients if they injured outside the
United States.. Answer: b. They cover deductibles, copayments, and
coinsurances usually.
◉ A 21 year-old patient presents for fillings for two if his teeth. Are
these services covered under EPSDT?
a. No, because these types of services are not covered.
b. Yes, if the patient lives in a state that covers dental services.
c. No, because the patient is not under the age of 21.
d. Yes, all services are covered under Medicaid.. Answer: c. No,
because the patient is not under the age of 21.
,◉ A Medicare patient has prescription drug coverage, but does not
have Medicare Advantage. What Medicare coverage does the patient
have for his medications?
a. Part A
b. Part B
c. Part C
d. Part D. Answer: d. Part D
◉ A Medicare patient presents for her pelvic, pap, and breast
examination (PPB). The patient is not sure when she had her last
PPB. As she is checking out, the front desk rep has her sign an ABN.
The service is billed and denied for frequency. Can the patient be
balance billed? Why?
a. Yes. It does not matter when you get an ABN signed.
b. No. The ABN must be signed before the service is performed.
c. Yes, as long as the patient has met her deductible.
d. No. An ABN is not required, but the patient is required to pay at
time of service or the bill has to be written off.. Answer: b. No. The
ABN must be signed before the service is performed.
, ◉ A Medicare patient presents with an injury sustained at his part-
time job. His injury status is verified by his company. After services
are rendered, in what order are the claims submitted?
a. The worker's compensation is primary, and Medicare is secondary
b. Either may be filed first, whichever pays better
c. Medicare is primary, and Worker's compensation is secondary
d. The patient must pay for services and files claims himself. Answer:
a. The worker's compensation is primary, and Medicare is secondary
◉ A Medicare patient is seen by her physician. The physician has
opted out of the Medicare program. The patient and physician have a
private contract. The charges for the services rendered are $300.00.
Medicare's approved amount would be $200.00. What can the office
charge this patient?
a. $160.00 (80 percent of the approved amount)
b. $218.50 (115 percent of the approved amount for non-Par
providers)
c. $300.00
d. $250.00. Answer: c. $300.00
◉ Medicare's payment amount for services are determined by which
of the following formulas?
COMPLETE QUESTIONS WITH SOLUTIONS
GRADED A+
◉ A patient has Medicare and a Medigap policy. Box 13, signature on
file, is checked off on the electronic claim submission. An EOMB is
received with remittance notice MA19. What does the office need to
do?
a. Nothing. This means the claim has been crossed over to the
Medigap plan.
b. The biller must file the secondary insurance as the cross-over
claim is not going to be sent due to missing information.
c. The biller must check the claim filed for missing information, add
the missing information, and send back to Medicare for processing.
d. Nothing. The notice means that the patient is responsible for the
bill.. Answer: b. The biller must file the secondary insurance as the
cross-over claim is not going to be sent due to missing information.
◉ A Medicare patient receives services from a participating provider
on January 6, 2016, but the charges are missed and don't get entered
in to the computer. How long does the office have to bill Medicare for
the services?
,a. 3 months
b. 12 months
c. 6 months
d. 1 month. Answer: b. 12 months
◉ What is true regarding Medigap policies?
a. They cover everything that Medicare does not.
b. They cover deductibles, copayments, and coinsurances usually.
c. All Medigap policies are the same and offer the same coverage.
d. Medigap policies must cover patients if they injured outside the
United States.. Answer: b. They cover deductibles, copayments, and
coinsurances usually.
◉ A 21 year-old patient presents for fillings for two if his teeth. Are
these services covered under EPSDT?
a. No, because these types of services are not covered.
b. Yes, if the patient lives in a state that covers dental services.
c. No, because the patient is not under the age of 21.
d. Yes, all services are covered under Medicaid.. Answer: c. No,
because the patient is not under the age of 21.
,◉ A Medicare patient has prescription drug coverage, but does not
have Medicare Advantage. What Medicare coverage does the patient
have for his medications?
a. Part A
b. Part B
c. Part C
d. Part D. Answer: d. Part D
◉ A Medicare patient presents for her pelvic, pap, and breast
examination (PPB). The patient is not sure when she had her last
PPB. As she is checking out, the front desk rep has her sign an ABN.
The service is billed and denied for frequency. Can the patient be
balance billed? Why?
a. Yes. It does not matter when you get an ABN signed.
b. No. The ABN must be signed before the service is performed.
c. Yes, as long as the patient has met her deductible.
d. No. An ABN is not required, but the patient is required to pay at
time of service or the bill has to be written off.. Answer: b. No. The
ABN must be signed before the service is performed.
, ◉ A Medicare patient presents with an injury sustained at his part-
time job. His injury status is verified by his company. After services
are rendered, in what order are the claims submitted?
a. The worker's compensation is primary, and Medicare is secondary
b. Either may be filed first, whichever pays better
c. Medicare is primary, and Worker's compensation is secondary
d. The patient must pay for services and files claims himself. Answer:
a. The worker's compensation is primary, and Medicare is secondary
◉ A Medicare patient is seen by her physician. The physician has
opted out of the Medicare program. The patient and physician have a
private contract. The charges for the services rendered are $300.00.
Medicare's approved amount would be $200.00. What can the office
charge this patient?
a. $160.00 (80 percent of the approved amount)
b. $218.50 (115 percent of the approved amount for non-Par
providers)
c. $300.00
d. $250.00. Answer: c. $300.00
◉ Medicare's payment amount for services are determined by which
of the following formulas?
