AAPC Certified Professional Biller (CPB)® certification Practice Exam
2025 verified questions and answer
Joe and Mary are a married couple and both carry insurance from their
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employers. Joe was born on February 23, 1977 and Mary was born on April 4,
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1974. Using the birthday rule, who carries the primary insurance for their
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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 andJoe's date of birth is the 23rd.
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C. Mary, because her birth year is before Joe's birth year. w1 w1 w1 w1 w1 w1 w1 w1 w1
D. Joe, because his birth month and day are before Mary's birth month and day. -
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The correct answer is D. Joe, because his birth month and day are before
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Mary's birth month and day.
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Which type of managed care insurance allows patients to self-refer to out-of-
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network providers and pay a higher co-insurance/copay amount? w1 w1 w1 w1 w1 w1 w1
I. HMO
II. PPO
III. EPO
IV. POS
V. Capitation
A. II
B. IV
C. II and IV w1 w1
D. II, III, and V - The correct answer is C. II and IV
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A patient covered by a PPO is scheduled for knee replacement surgery. The
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biller contacts the insurance carrier to verify benefits and preauthorize the
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procedure. The carrier verifies the patient has a $500 deductible which must be
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met. After the deductible, the PPO will pay 80% of the claim. The contracted rate
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for the procedure is $2,500. What is the patient's responsibility?
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A. $400
2025 verified questions and answer
Joe and Mary are a married couple and both carry insurance from their
w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1
employers. Joe was born on February 23, 1977 and Mary was born on April 4,
w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1
1974. Using the birthday rule, who carries the primary insurance for their
w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1
children for billing?
w1 w1 w1
A. Joe, because he is the male head of the household.
w1 w1 w1 w1 w1 w1 w1 w1 w1
B. Mary, because her date of birth is the 4th andJoe's date of birth is the 23rd.
w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1
C. Mary, because her birth year is before Joe's birth year. w1 w1 w1 w1 w1 w1 w1 w1 w1
D. Joe, because his birth month and day are before Mary's birth month and day. -
w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1
The correct answer is D. Joe, because his birth month and day are before
w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1
Mary's birth month and day.
w1 w1 w1 w1 w1
Which type of managed care insurance allows patients to self-refer to out-of-
w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1
network providers and pay a higher co-insurance/copay amount? w1 w1 w1 w1 w1 w1 w1
I. HMO
II. PPO
III. EPO
IV. POS
V. Capitation
A. II
B. IV
C. II and IV w1 w1
D. II, III, and V - The correct answer is C. II and IV
w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1
A patient covered by a PPO is scheduled for knee replacement surgery. The
w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1
biller contacts the insurance carrier to verify benefits and preauthorize the
w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1
procedure. The carrier verifies the patient has a $500 deductible which must be
w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1
met. After the deductible, the PPO will pay 80% of the claim. The contracted rate
w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1 w1
for the procedure is $2,500. What is the patient's responsibility?
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A. $400
