2
AAPC CPB Practice Exam questions with verified detailed answers
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Joe and Mary are a married couple and both carry insurance from their employers. Joe was
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born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule,
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who carries the primary insurance for their children for billing?
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A. Joe, because he is the male head of the household.
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B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd.
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C. Mary, because her birth year is before Joe's birth year.
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D. Joe, because his birth month and day are before Mary's birth month and day. - ✔✔D. Joe,
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because his birth month and day are before Mary's birth month and day.
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Which type of managed care insurance allows patients to self-refer to out-of-network
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providers and pay a higher co-insurance/copay amount? || || || || || || ||
I. HMO
||
II. PPO ||
III. EPO ||
IV. POS ||
V. Capitation
||
A. II || ||
B. IV || ||
C. II and IV
|| || || ||
D. II, III, and V - ✔✔C. II and IV
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,2
A patient covered by a PPO is scheduled for knee replacement surgery. The biller contacts
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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 - ✔✔C. $900
|| || || ||
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.
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B. The payment is sent to the provider if the provider agrees to accept assignment.
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C. The payment is sent to the provider regardless if he accepts assignment.
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D. The claim is not paid because the provider is not participating in the plan. - ✔✔A. The
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payment is sent to the patient and the patient must pay the provider.
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Which of the following TRICARE options is/are available to active duty service members?
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||
A. TRICARE Select
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B. TRICARE Prime
|| || ||
C. TRICARE For Life
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D. TRICARE Young Adult - ✔✔B. TRICARE Prime
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A Medicare card will list which of the following:
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,2
||
I. Effective date of coverage
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II. Home address
|| ||
III. Telephone Number|| ||
IV. Entitled to Part A and/or Part B
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V. When coverage ends
|| || ||
VI. Name of Primary Care Physician
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||
A. I - VI || || || ||
B. I, IV || || ||
C. I-III, VI
|| || ||
D. I, II, IV, V - ✔✔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 ||
II. A 72 year-old patient who participates in the group health insurance of his employer
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III. A 66 year-old patient is injured at work and the employer does not offer health
|| || || || || || || || || || || || || || || ||
insurance as a benefit of employment || || || || ||
IV. A 55 year-old patient who is on disability through Social Security and qualifies for
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Medicaid and Medicare || || ||
A. I-IV || ||
B. II and III
|| || || ||
C. I and IV|| || || ||
D. None - ✔✔B. II and III
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, 2
When a patient has Medicare primary and AARP as Medigap, what is entered on the CMS-
|| || || || || || || || || || || || || || ||
1500 claim form in item 9d for the Insurance Plan Name or Program Name for Medicare to
|| || || || || || || || || || || || || || || || ||
cross over the claim? || || ||
||
A. Plan name followed by "MEDIGAP"
|| || || || || ||
B. Plan Payer ID followed by "MEDIGAP"
|| || || || || || ||
C. COBA Medigap claim-based identifier (ID)
|| || || || || ||
D. Leave blank - ✔✔C. COBA Medigap claim-based identifier (ID)
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Which guidelines must all billing personnel be knowledgeable about in order to ensure
|| || || || || || || || || || || || ||
compliance with Medicaid programs? || || ||
||
A. Federal guidelines
|| || ||
B. State guidelines
|| || ||
C. Both A and B
|| || || || ||
D. None - ✔✔C. Both A and B
|| || || || || || ||
Which of the following services is covered by Early and Periodic Screening, Diagnostic, and
|| || || || || || || || || || || || || ||
Treatment (EPSDT)? ||
||
A. Family planning
|| || ||
B. Obstetric care
|| || ||
C. Pediatric checkups
|| || ||
D. Emergency department visits - ✔✔C. Pediatric checkups
|| || || || || || ||
A female patient who was involved in an auto accident presents to the emergency
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department (ED) for evaluation. She does not have any complaints. The provider evaluates|| || || || || || || || || || || || ||
her and determines there are no injuries. The provider informs the patient to come back to
|| || || || || || || || || || || || || || || ||
the ED or see her primary care physician if she develops any symptoms. How is the claim
|| || || || || || || || || || || || || || || || ||
processed for this encounter? || || || ||
AAPC CPB Practice Exam questions with verified detailed 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. - ✔✔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 ||
V. Capitation
||
A. II || ||
B. IV || ||
C. II and IV
|| || || ||
D. II, III, and V - ✔✔C. II and IV
|| || || || || || || || ||
,2
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 - ✔✔C. $900
|| || || ||
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. - ✔✔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 - ✔✔B. TRICARE Prime
|| || || || || || ||
A Medicare card will list which of the following:
|| || || || || || || ||
,2
||
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 - ✔✔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 ||
II. A 72 year-old patient who participates in the group health insurance of his employer
|| || || || || || || || || || || || || ||
III. A 66 year-old patient is injured at work and the employer does not offer health
|| || || || || || || || || || || || || || || ||
insurance as a benefit of employment || || || || ||
IV. A 55 year-old patient who is on disability through Social Security and qualifies for
|| || || || || || || || || || || || || || ||
Medicaid and Medicare || || ||
A. I-IV || ||
B. II and III
|| || || ||
C. I and IV|| || || ||
D. None - ✔✔B. II and III
|| || || || || ||
, 2
When a patient has Medicare primary and AARP as Medigap, what is entered on the CMS-
|| || || || || || || || || || || || || || ||
1500 claim form in item 9d for the Insurance Plan Name or Program Name for Medicare to
|| || || || || || || || || || || || || || || || ||
cross over the claim? || || ||
||
A. Plan name followed by "MEDIGAP"
|| || || || || ||
B. Plan Payer ID followed by "MEDIGAP"
|| || || || || || ||
C. COBA Medigap claim-based identifier (ID)
|| || || || || ||
D. Leave blank - ✔✔C. COBA Medigap claim-based identifier (ID)
|| || || || || || || || ||
Which guidelines must all billing personnel be knowledgeable about in order to ensure
|| || || || || || || || || || || || ||
compliance with Medicaid programs? || || ||
||
A. Federal guidelines
|| || ||
B. State guidelines
|| || ||
C. Both A and B
|| || || || ||
D. None - ✔✔C. Both A and B
|| || || || || || ||
Which of the following services is covered by Early and Periodic Screening, Diagnostic, and
|| || || || || || || || || || || || || ||
Treatment (EPSDT)? ||
||
A. Family planning
|| || ||
B. Obstetric care
|| || ||
C. Pediatric checkups
|| || ||
D. Emergency department visits - ✔✔C. Pediatric checkups
|| || || || || || ||
A female patient who was involved in an auto accident presents to the emergency
|| || || || || || || || || || || || || ||
department (ED) for evaluation. She does not have any complaints. The provider evaluates|| || || || || || || || || || || || ||
her and determines there are no injuries. The provider informs the patient to come back to
|| || || || || || || || || || || || || || || ||
the ED or see her primary care physician if she develops any symptoms. How is the claim
|| || || || || || || || || || || || || || || || ||
processed for this encounter? || || || ||
