OVER 150 AAPC CPB FINAL EXAM QUESTIONS 2026/2027 ||
COMPREHENSIVE MEDICAL BILLING CERTIFICATION
EXAM PREPARATION WITH UPDATED GUIDELINES AND
STRUCTURED REVIEW SUPPORT || REAL CPB EXAM-STYLE
QUESTIONS WITH VERIFIED DETAILED ACCURATE
ANSWERS LATEST EDITION || ELITE A+ PREMIUM QUALITY
GUARANTEED
The answer is immediately after the question
A 6 year-old is seen in the pediatrician office for the first time. He has insurance
coverage through both his mother (DOB: 02/08/86 and his father (DOB:
05/15/85). Whose insurance is primary?
A. Mother's insurance plan
B. Father's insurance plan
C. The policy that has the best benefits
D. Either mother's or father's insurance plan depending who brings the child in
for medical care.
A. Mother's insurance plan
Which managed care plan has the patient receiving care from participating
providers (network provider) and the providers are only paid for services
provided?
A. Health Maintenance Organization (HMO)
B. Point-of-Service Plan (POS)
C. Exclusive Provider Organization (EPO)
D. Integrated Delivery System (IDS)
C. Exclusive Provider Organization (EPO)
EPO is a managed care plan in which enrollees must receive their care from
doctors and hospitals within the EPO network but cannot go outside of the
network for care. If an enrollee goes to a provider or hospital outside of the
network the enrollee will have to pay the medical bills out of pocket. A network
provider for EPO plans is reimbursed on fee-for-service basis.
Which TRICARE plan is similar to an HMO plan?
A. TRICARE For Life
,B. TRICARE Select
C. TRICARE Prime
D. TRICARE Young Adult
C. TRICARE Prime
TRICARE Prime is one of the three healthcare options that is similar to an HMO
plan as the patient is assigned a PCP and the treatment goes
through the PCP.
Which of the services are covered by Medicare Part A?
I. Skilled Nursing Facility Care
II. Ambulatory Surgery
III. Durable Medical Equipment
IV. Hospice Care
V. Home Health Services
VI. Long Term Care
VII. Outpatient prescription drugs
A. I-VII
B. II, III, VI
C. I, II, IV, VII
D. I, IV, V
D. I, IV, V
Medicare Part A covers hospital care, skilled nursing facility care, nursing home
care, hospice, and home health services.
Which is a TRUE statement regarding Workers' Compensation?
A. There is no copayment for the injured worker in workers' compensation cases.
B. The filing deadline for a first report of injury form is one week from the date
of the accident.
C. Providers can balance bill a patient when compensation payment is not paid in
full.
D. There is a deductible for the injured worker in workers' compensation claims.
A. There is no copayment for the injured worker in workers' compensation cases.
There is no co-payment for workers' compensation cases. A worker (employee)
cannot be given a bill for co-pay or anything else because it is the insurance policy
of the employer, and not the workers' personal policy, that pays the bill. The filing
deadline for a first report of injury form is determined by state law. All providers
,must accept the compensation payment as payment in full. There is no deductible
in workers' compensation.
Bob sees his family physician for seasonal allergies. Before leaving, Bob pays the
charge for the office visit. As a courtesy, the physician's staff submits a claim to
Bob's insurance company. If the service is covered by the insurance company,
Bob can expect to be reimbursed for the office visit. This is which type of
insurance model?
A. Healthcare Anywhere
B. Managed Care Plan
C. Fee-for-service (traditional coverage)
D. Health Maintenance Organization (HMO)
C. Fee-for-service (traditional coverage)
Blue Cross/Blue Shield fee-for-service (traditional coverage) plan is selected by
individuals who do not have the access to a group plan, and for small business
employers. The plan has two types of coverage, basic coverage and major medical
benefits.
Which of the following benefits are NOT covered by all Medigap policies?
I. Part A co-insurance and hospital costs
II. Skilled nursing facility care co-insurance
III. Parts A & B deductible
IV. Part B excess charges
V. Foreign travel exchange
A. I, II, III
B. I, III
C. I, IV, V
D. II, III, IV, V
D. II, III, IV, V
Medigap is required to cover Part A coinsurance and hospital costs. The
remaining items are only covered by some of the Medigap policies.
Medicaid eligibility is primarily determined by?
A. Income
B. Prior insurance coverage
, C. Marital status
D. Number of living relatives
A. Income
____________ is incorporated by CMS into the NCCI program to limit the
number of times a service or procedure can be reported by a physician on the
same date of service to a patient.
A. Outpatient Code Editor (OCE)
B. Medically Unlikely Edits (MUE)
C. Physician Fee Schedule
D. National Coverage Determination (NCD)
B. Medically Unlikely Edits (MUE)
Medically unlikely edits (MUE), which are units of service edits, was
implemented by CMS into the NCCI program to limit the number of times a
service or procedure can be reported by a physician on the same date of service
to an individual patient. CMS developed the MUE program to reduce the error
rate for Part B coding and to control improper payments.
In the CPT® codebook, which of the following codes may be used for reporting
synchronous telemedicine services when appended by modifier 95?
A. 93000
B. 99441
C. 99225
D. 99253
D. 99253
99253 has the star symbol next to it. The star symbol identifies codes that can be
used for reporting synchronous telemedicine services when appended by modifier
95 (see Appendix P).
Which service is NOT included in the global package for surgical procedures?
A. Treatment for postoperative complications that require a return trip to the OR.
B. Writing orders
C. Evaluating the patient in the Post-Anesthesia Care Unit
D. Local infiltration, digital block, topical anesthesia
A. Treatment for postoperative complications that require a return trip to the OR.
COMPREHENSIVE MEDICAL BILLING CERTIFICATION
EXAM PREPARATION WITH UPDATED GUIDELINES AND
STRUCTURED REVIEW SUPPORT || REAL CPB EXAM-STYLE
QUESTIONS WITH VERIFIED DETAILED ACCURATE
ANSWERS LATEST EDITION || ELITE A+ PREMIUM QUALITY
GUARANTEED
The answer is immediately after the question
A 6 year-old is seen in the pediatrician office for the first time. He has insurance
coverage through both his mother (DOB: 02/08/86 and his father (DOB:
05/15/85). Whose insurance is primary?
A. Mother's insurance plan
B. Father's insurance plan
C. The policy that has the best benefits
D. Either mother's or father's insurance plan depending who brings the child in
for medical care.
A. Mother's insurance plan
Which managed care plan has the patient receiving care from participating
providers (network provider) and the providers are only paid for services
provided?
A. Health Maintenance Organization (HMO)
B. Point-of-Service Plan (POS)
C. Exclusive Provider Organization (EPO)
D. Integrated Delivery System (IDS)
C. Exclusive Provider Organization (EPO)
EPO is a managed care plan in which enrollees must receive their care from
doctors and hospitals within the EPO network but cannot go outside of the
network for care. If an enrollee goes to a provider or hospital outside of the
network the enrollee will have to pay the medical bills out of pocket. A network
provider for EPO plans is reimbursed on fee-for-service basis.
Which TRICARE plan is similar to an HMO plan?
A. TRICARE For Life
,B. TRICARE Select
C. TRICARE Prime
D. TRICARE Young Adult
C. TRICARE Prime
TRICARE Prime is one of the three healthcare options that is similar to an HMO
plan as the patient is assigned a PCP and the treatment goes
through the PCP.
Which of the services are covered by Medicare Part A?
I. Skilled Nursing Facility Care
II. Ambulatory Surgery
III. Durable Medical Equipment
IV. Hospice Care
V. Home Health Services
VI. Long Term Care
VII. Outpatient prescription drugs
A. I-VII
B. II, III, VI
C. I, II, IV, VII
D. I, IV, V
D. I, IV, V
Medicare Part A covers hospital care, skilled nursing facility care, nursing home
care, hospice, and home health services.
Which is a TRUE statement regarding Workers' Compensation?
A. There is no copayment for the injured worker in workers' compensation cases.
B. The filing deadline for a first report of injury form is one week from the date
of the accident.
C. Providers can balance bill a patient when compensation payment is not paid in
full.
D. There is a deductible for the injured worker in workers' compensation claims.
A. There is no copayment for the injured worker in workers' compensation cases.
There is no co-payment for workers' compensation cases. A worker (employee)
cannot be given a bill for co-pay or anything else because it is the insurance policy
of the employer, and not the workers' personal policy, that pays the bill. The filing
deadline for a first report of injury form is determined by state law. All providers
,must accept the compensation payment as payment in full. There is no deductible
in workers' compensation.
Bob sees his family physician for seasonal allergies. Before leaving, Bob pays the
charge for the office visit. As a courtesy, the physician's staff submits a claim to
Bob's insurance company. If the service is covered by the insurance company,
Bob can expect to be reimbursed for the office visit. This is which type of
insurance model?
A. Healthcare Anywhere
B. Managed Care Plan
C. Fee-for-service (traditional coverage)
D. Health Maintenance Organization (HMO)
C. Fee-for-service (traditional coverage)
Blue Cross/Blue Shield fee-for-service (traditional coverage) plan is selected by
individuals who do not have the access to a group plan, and for small business
employers. The plan has two types of coverage, basic coverage and major medical
benefits.
Which of the following benefits are NOT covered by all Medigap policies?
I. Part A co-insurance and hospital costs
II. Skilled nursing facility care co-insurance
III. Parts A & B deductible
IV. Part B excess charges
V. Foreign travel exchange
A. I, II, III
B. I, III
C. I, IV, V
D. II, III, IV, V
D. II, III, IV, V
Medigap is required to cover Part A coinsurance and hospital costs. The
remaining items are only covered by some of the Medigap policies.
Medicaid eligibility is primarily determined by?
A. Income
B. Prior insurance coverage
, C. Marital status
D. Number of living relatives
A. Income
____________ is incorporated by CMS into the NCCI program to limit the
number of times a service or procedure can be reported by a physician on the
same date of service to a patient.
A. Outpatient Code Editor (OCE)
B. Medically Unlikely Edits (MUE)
C. Physician Fee Schedule
D. National Coverage Determination (NCD)
B. Medically Unlikely Edits (MUE)
Medically unlikely edits (MUE), which are units of service edits, was
implemented by CMS into the NCCI program to limit the number of times a
service or procedure can be reported by a physician on the same date of service
to an individual patient. CMS developed the MUE program to reduce the error
rate for Part B coding and to control improper payments.
In the CPT® codebook, which of the following codes may be used for reporting
synchronous telemedicine services when appended by modifier 95?
A. 93000
B. 99441
C. 99225
D. 99253
D. 99253
99253 has the star symbol next to it. The star symbol identifies codes that can be
used for reporting synchronous telemedicine services when appended by modifier
95 (see Appendix P).
Which service is NOT included in the global package for surgical procedures?
A. Treatment for postoperative complications that require a return trip to the OR.
B. Writing orders
C. Evaluating the patient in the Post-Anesthesia Care Unit
D. Local infiltration, digital block, topical anesthesia
A. Treatment for postoperative complications that require a return trip to the OR.
