AAPC CPB - Practice Exam A/ AAPC CPB -
Practice Exam B/ AAPC CPB - Practice Exam C/
AAPC CPB Final/ Questions with Certified
Answers
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 - Answer: 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
Page 1 of 68
,B. State guidelines
C. Both A and B
D. None - Answer: 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 - Answer: 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?
A. The medical insurance is billed primary and the auto insurance is billed secondary.
B. The auto insurance is billed primary and the medical insurance is billed secondary.
C. Bill the medical insurance first to receive a denial and then submit with the remittance advice
to the auto insurance.
D. Bill only the medical insurance because the auto insurance only covers damage to the
vehicle, not medical expenses. - Answer: B. The auto insurance is billed primary and the medical
insurance is billed secondary.
What forms need to be submitted when billing for a work-related injury?
A. Progress reports, and WC-1500 claim form
B. UB-04
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,C. First Report of Injury form and an itemized statement
D. First Report of Injury form, progress reports, and CMS-1500 claim form - Answer: D. First
Report of Injury form, progress reports, and CMS-1500 claim form
A document provided to Medicare patients explaining their financial responsibility if Medicare
denies a service is a(n):
A. Notice of Financial Liability
B. Advance Beneficiary Notice
C. Insurance waiver
D. Explanation of Benefits - Answer: B. Advance Beneficiary Notice
What is an Accountable Care Organization (ACO)?
A. Groups of doctors, hospitals, and other health care providers who coordinate high quality
care to Medicare patients.
B. An insurance carrier that provides a set fee based on the diagnosis of the patient.
C. A group of providers who contract with a third party administrator to pay fee for service for
services.
D. Hospitals who see a subset of patients for cost efficiency. - Answer: A. Groups of doctors,
hospitals, and other health care providers who coordinate high quality care to Medicare
patients.
A new patient presents for her annual exam and has no complaints. She is scheduled to see the
physician assistant (PA). How should services be billed ?
A. Bill under the PA.
B. A new patient can be billed incident to the physician.
C. The PA cannot see new patients.
D. Reschedule the patient with the physician - Answer: A. Bill under the PA.
Page 3 of 68
, CPT® codes 12032 and 12001 were reported together for a 2.6 cm intermediate repair of a
laceration to the right arm and a 2.5 cm simple repair of a laceration to the left arm. 12001 was
denied as a bundled service. What action should be taken by the biller (following the CPT®
guidelines)?
A. Write-off the charge for 12001 as it is a bundled procedure.
B. Resubmit a corrected claim as 12032, 12001-59.
C. Transfer the charge to patient responsibility.
D. Resubmit a corrected claim as 12032, 12001-51. - Answer: B. Resubmit a corrected claim as
12032, 12001-59.
According to CMS, which of the following services are included in the global package for surgical
procedures?
I. Surgical procedure performed
II. E/M visits unrelated to the diagnosis for which the surgical procedure is performed
III. Local infiltration, digital block, or topical anesthesia
IV. Treatment for postoperative complication which requires a return trip to the operating room
(OR)V. Writing Orders
VI. Postoperative infection treated in the office
A. I, III, V, VI
B. I, IV, V
C. I, II, III, V
D. I-VI - Answer: A. I, III, V, VI
Which CPT® code below can be reported with modifier 51?
A. 17004
Page 4 of 68
Practice Exam B/ AAPC CPB - Practice Exam C/
AAPC CPB Final/ Questions with Certified
Answers
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 - Answer: 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
Page 1 of 68
,B. State guidelines
C. Both A and B
D. None - Answer: 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 - Answer: 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?
A. The medical insurance is billed primary and the auto insurance is billed secondary.
B. The auto insurance is billed primary and the medical insurance is billed secondary.
C. Bill the medical insurance first to receive a denial and then submit with the remittance advice
to the auto insurance.
D. Bill only the medical insurance because the auto insurance only covers damage to the
vehicle, not medical expenses. - Answer: B. The auto insurance is billed primary and the medical
insurance is billed secondary.
What forms need to be submitted when billing for a work-related injury?
A. Progress reports, and WC-1500 claim form
B. UB-04
Page 2 of 68
,C. First Report of Injury form and an itemized statement
D. First Report of Injury form, progress reports, and CMS-1500 claim form - Answer: D. First
Report of Injury form, progress reports, and CMS-1500 claim form
A document provided to Medicare patients explaining their financial responsibility if Medicare
denies a service is a(n):
A. Notice of Financial Liability
B. Advance Beneficiary Notice
C. Insurance waiver
D. Explanation of Benefits - Answer: B. Advance Beneficiary Notice
What is an Accountable Care Organization (ACO)?
A. Groups of doctors, hospitals, and other health care providers who coordinate high quality
care to Medicare patients.
B. An insurance carrier that provides a set fee based on the diagnosis of the patient.
C. A group of providers who contract with a third party administrator to pay fee for service for
services.
D. Hospitals who see a subset of patients for cost efficiency. - Answer: A. Groups of doctors,
hospitals, and other health care providers who coordinate high quality care to Medicare
patients.
A new patient presents for her annual exam and has no complaints. She is scheduled to see the
physician assistant (PA). How should services be billed ?
A. Bill under the PA.
B. A new patient can be billed incident to the physician.
C. The PA cannot see new patients.
D. Reschedule the patient with the physician - Answer: A. Bill under the PA.
Page 3 of 68
, CPT® codes 12032 and 12001 were reported together for a 2.6 cm intermediate repair of a
laceration to the right arm and a 2.5 cm simple repair of a laceration to the left arm. 12001 was
denied as a bundled service. What action should be taken by the biller (following the CPT®
guidelines)?
A. Write-off the charge for 12001 as it is a bundled procedure.
B. Resubmit a corrected claim as 12032, 12001-59.
C. Transfer the charge to patient responsibility.
D. Resubmit a corrected claim as 12032, 12001-51. - Answer: B. Resubmit a corrected claim as
12032, 12001-59.
According to CMS, which of the following services are included in the global package for surgical
procedures?
I. Surgical procedure performed
II. E/M visits unrelated to the diagnosis for which the surgical procedure is performed
III. Local infiltration, digital block, or topical anesthesia
IV. Treatment for postoperative complication which requires a return trip to the operating room
(OR)V. Writing Orders
VI. Postoperative infection treated in the office
A. I, III, V, VI
B. I, IV, V
C. I, II, III, V
D. I-VI - Answer: A. I, III, V, VI
Which CPT® code below can be reported with modifier 51?
A. 17004
Page 4 of 68
