AAPC CPB Practice Exam
t t t
JoetandtMarytaretatmarriedtcoupletandtbothtcarrytinsurancetfromttheirtemployers.tJoetwastborntontFeb
ruaryt23,t1977tandtMarytwastborntontAprilt4,t1974.tUsingtthetbirthdaytrule,twhotcarriestthetprimarytins
urancetforttheirtchildrentfortbilling?
A.tJoe,tbecausethetistthetmaletheadtoftthethousehold.t
B.tMary,tbecausethertdatetoftbirthtistthet4thtandtJoe'stdatetoftbirthtistthet23rd.t
C.tMary,tbecausethertbirthtyeartistbeforetJoe'stbirthtyear.t
D.tJoe,tbecausethistbirthtmonthtandtdaytaretbeforetMary'stbirthtmonthtandtday.t-t
✅D.tJoe,tbecausethistbirthtmonthtandtdaytaretbeforetMary'stbirthtmonthtandtday.
t
Whichttypetoftmanagedtcaretinsurancetallowstpatientsttotself-referttotout-of-
networktproviderstandtpaytathighertco-insurance/copaytamount?t
I.tHMO
II.tPPO
III.tEPO
IV.tPOS
V.tCapitation
A.tIIt
B.tIVt
C.tIItandtIVt
D.tII,tIII,tandtVt-t
✅C.tIItandtIV
t
AtpatienttcoveredtbytatPPOtistscheduledtfortkneetreplacementtsurgery.tThetbillertcontactstthetinsuranc
etcarrierttotverifytbenefitstandtpreauthorizetthetprocedure.tThetcarriertverifiestthetpatientthastat$500td
eductibletwhichtmusttbetmet.tAftertthetdeductible,tthetPPOtwilltpayt80%toftthetclaim.tThetcontractedtra
tetfortthetproceduretist$2,500.tWhattistthetpatient'stresponsibility?
1t|tP a g e
,A.t$400t
B.t$500t
C.t$900t
D.t$1,600t-t
✅C.t$900
t
WhentatnonparticipatingtprovidertfilestatclaimtfortatpatientttotBC/BS,thowtistthetpaymenttprocessed?t
A.tThetpaymenttistsentttotthetpatienttandtthetpatienttmusttpaytthetprovider.t
B.tThetpaymenttistsentttotthetprovidertiftthetprovidertagreesttotaccepttassignment.t
C.tThetpaymenttistsentttotthetprovidertregardlesstifthetacceptstassignment.t
D.tThetclaimtistnottpaidtbecausetthetprovidertistnottparticipatingtintthetplan.t-t
✅A.tThetpaymenttistsentttotthetpatienttandtthetpatienttmusttpaytthetprovider.
t
WhichtoftthetfollowingtTRICAREtoptionstis/aretavailablettotactivetdutytservicetmembers?
t
A.tTRICAREtSelectt
B.tTRICAREtPrimet
C.tTRICAREtFortLifet
D.tTRICAREtYoungtAdultt-t
✅B.tTRICAREtPrime
t
AtMedicaretcardtwilltlisttwhichtoftthetfollowing:
t
I.tEffectivetdatetoftcoverage
II.tHometaddress
III.tTelephonetNumber
IV.tEntitledttotParttAtand/ortParttB
V.tWhentcoveragetends
VI.tNametoftPrimarytCaretPhysician
t
A.tIt-tVIt
2t|tP a g e
,B.tI,tIVt
C.tI-III,tVIt
D.tI,tII,tIV,tVt-t
✅B.tI,tIV
t
IntwhichtoftthetfollowingtscenariostistMedicaretthetsecondarytpayer?
I.tAt65tyear-
oldtpatienttwhotistcollectingthertdeceasedtspouse'stMedicaretbenefitstandthastatsupplementaltinsuranc
e
II.tAt72tyear-oldtpatienttwhotparticipatestintthetgroupthealthtinsurancetofthistemployer
III.tAt66tyear-
oldtpatienttistinjuredtattworktandtthetemployertdoestnottofferthealthtinsurancetastatbenefittoftemploym
ent
IV.tAt55tyear-
oldtpatienttwhotistontdisabilitytthroughtSocialtSecuritytandtqualifiestfortMedicaidtandtMedicaret
A.tI-IVt
B.tIItandtIIIt
C.tItandtIVt
D.tNonet-t
✅B.tIItandtIII
t
WhentatpatientthastMedicaretprimarytandtAARPtastMedigap,twhattistenteredtontthetCMS-
1500tclaimtformtintitemt9dtfortthetInsurancetPlantNametortProgramtNametfortMedicarettotcrosstovertth
etclaim?
t
A.tPlantnametfollowedtbyt"MEDIGAP"t
B.tPlantPayertIDtfollowedtbyt"MEDIGAP"t
C.tCOBAtMedigaptclaim-basedtidentifiert(ID)t
D.tLeavetblankt-t
✅C.tCOBAtMedigaptclaim-basedtidentifiert(ID)
t
3t|tP a g e
, Whichtguidelinestmusttalltbillingtpersonneltbetknowledgeabletabouttintorderttotensuretcompliancetwit
htMedicaidtprograms?
t
A.tFederaltguidelinest
B.tStatetguidelinest
C.tBothtAtandtBt
D.tNonet-t
✅C.tBothtAtandtB
t
WhichtoftthetfollowingtservicestistcoveredtbytEarlytandtPeriodictScreening,tDiagnostic,tandtTreatmentt(
EPSDT)?
t
A.tFamilytplanningt
B.tObstetrictcaret
C.tPediatrictcheckupst
D.tEmergencytdepartmenttvisitst-t
✅C.tPediatrictcheckups
t
Atfemaletpatienttwhotwastinvolvedtintantautotaccidenttpresentsttotthetemergencytdepartmentt(ED)tfort
evaluation.tShetdoestnotthavetanytcomplaints.tThetprovidertevaluatesthertandtdeterminesttheretaretnot
injuries.tThetprovidertinformstthetpatientttotcometbackttotthetEDtortseethertprimarytcaretphysiciantiftsh
etdevelopstanytsymptoms.tHowtistthetclaimtprocessedtfortthistencounter?t
A.tThetmedicaltinsurancetistbilledtprimarytandtthetautotinsurancetistbilledtsecondary.t
B.tThetautotinsurancetistbilledtprimarytandtthetmedicaltinsurancetistbilledtsecondary.t
C.tBilltthetmedicaltinsurancetfirstttotreceivetatdenialtandtthentsubmittwithtthetremittancetadvicettottheta
utotinsurance.t
D.tBilltonlytthetmedicaltinsurancetbecausetthetautotinsurancetonlytcoverstdamagettotthetvehicle,tnottm
edicaltexpenses.t-t
✅B.tThetautotinsurancetistbilledtprimarytandtthetmedicaltinsurancetistbilledtsecondary.
t
Whattformstneedttotbetsubmittedtwhentbillingtfortatwork-relatedtinjury?
t
A.tProgresstreports,tandtWC-1500tclaimtformt
4t|tP a g e
t t t
JoetandtMarytaretatmarriedtcoupletandtbothtcarrytinsurancetfromttheirtemployers.tJoetwastborntontFeb
ruaryt23,t1977tandtMarytwastborntontAprilt4,t1974.tUsingtthetbirthdaytrule,twhotcarriestthetprimarytins
urancetforttheirtchildrentfortbilling?
A.tJoe,tbecausethetistthetmaletheadtoftthethousehold.t
B.tMary,tbecausethertdatetoftbirthtistthet4thtandtJoe'stdatetoftbirthtistthet23rd.t
C.tMary,tbecausethertbirthtyeartistbeforetJoe'stbirthtyear.t
D.tJoe,tbecausethistbirthtmonthtandtdaytaretbeforetMary'stbirthtmonthtandtday.t-t
✅D.tJoe,tbecausethistbirthtmonthtandtdaytaretbeforetMary'stbirthtmonthtandtday.
t
Whichttypetoftmanagedtcaretinsurancetallowstpatientsttotself-referttotout-of-
networktproviderstandtpaytathighertco-insurance/copaytamount?t
I.tHMO
II.tPPO
III.tEPO
IV.tPOS
V.tCapitation
A.tIIt
B.tIVt
C.tIItandtIVt
D.tII,tIII,tandtVt-t
✅C.tIItandtIV
t
AtpatienttcoveredtbytatPPOtistscheduledtfortkneetreplacementtsurgery.tThetbillertcontactstthetinsuranc
etcarrierttotverifytbenefitstandtpreauthorizetthetprocedure.tThetcarriertverifiestthetpatientthastat$500td
eductibletwhichtmusttbetmet.tAftertthetdeductible,tthetPPOtwilltpayt80%toftthetclaim.tThetcontractedtra
tetfortthetproceduretist$2,500.tWhattistthetpatient'stresponsibility?
1t|tP a g e
,A.t$400t
B.t$500t
C.t$900t
D.t$1,600t-t
✅C.t$900
t
WhentatnonparticipatingtprovidertfilestatclaimtfortatpatientttotBC/BS,thowtistthetpaymenttprocessed?t
A.tThetpaymenttistsentttotthetpatienttandtthetpatienttmusttpaytthetprovider.t
B.tThetpaymenttistsentttotthetprovidertiftthetprovidertagreesttotaccepttassignment.t
C.tThetpaymenttistsentttotthetprovidertregardlesstifthetacceptstassignment.t
D.tThetclaimtistnottpaidtbecausetthetprovidertistnottparticipatingtintthetplan.t-t
✅A.tThetpaymenttistsentttotthetpatienttandtthetpatienttmusttpaytthetprovider.
t
WhichtoftthetfollowingtTRICAREtoptionstis/aretavailablettotactivetdutytservicetmembers?
t
A.tTRICAREtSelectt
B.tTRICAREtPrimet
C.tTRICAREtFortLifet
D.tTRICAREtYoungtAdultt-t
✅B.tTRICAREtPrime
t
AtMedicaretcardtwilltlisttwhichtoftthetfollowing:
t
I.tEffectivetdatetoftcoverage
II.tHometaddress
III.tTelephonetNumber
IV.tEntitledttotParttAtand/ortParttB
V.tWhentcoveragetends
VI.tNametoftPrimarytCaretPhysician
t
A.tIt-tVIt
2t|tP a g e
,B.tI,tIVt
C.tI-III,tVIt
D.tI,tII,tIV,tVt-t
✅B.tI,tIV
t
IntwhichtoftthetfollowingtscenariostistMedicaretthetsecondarytpayer?
I.tAt65tyear-
oldtpatienttwhotistcollectingthertdeceasedtspouse'stMedicaretbenefitstandthastatsupplementaltinsuranc
e
II.tAt72tyear-oldtpatienttwhotparticipatestintthetgroupthealthtinsurancetofthistemployer
III.tAt66tyear-
oldtpatienttistinjuredtattworktandtthetemployertdoestnottofferthealthtinsurancetastatbenefittoftemploym
ent
IV.tAt55tyear-
oldtpatienttwhotistontdisabilitytthroughtSocialtSecuritytandtqualifiestfortMedicaidtandtMedicaret
A.tI-IVt
B.tIItandtIIIt
C.tItandtIVt
D.tNonet-t
✅B.tIItandtIII
t
WhentatpatientthastMedicaretprimarytandtAARPtastMedigap,twhattistenteredtontthetCMS-
1500tclaimtformtintitemt9dtfortthetInsurancetPlantNametortProgramtNametfortMedicarettotcrosstovertth
etclaim?
t
A.tPlantnametfollowedtbyt"MEDIGAP"t
B.tPlantPayertIDtfollowedtbyt"MEDIGAP"t
C.tCOBAtMedigaptclaim-basedtidentifiert(ID)t
D.tLeavetblankt-t
✅C.tCOBAtMedigaptclaim-basedtidentifiert(ID)
t
3t|tP a g e
, Whichtguidelinestmusttalltbillingtpersonneltbetknowledgeabletabouttintorderttotensuretcompliancetwit
htMedicaidtprograms?
t
A.tFederaltguidelinest
B.tStatetguidelinest
C.tBothtAtandtBt
D.tNonet-t
✅C.tBothtAtandtB
t
WhichtoftthetfollowingtservicestistcoveredtbytEarlytandtPeriodictScreening,tDiagnostic,tandtTreatmentt(
EPSDT)?
t
A.tFamilytplanningt
B.tObstetrictcaret
C.tPediatrictcheckupst
D.tEmergencytdepartmenttvisitst-t
✅C.tPediatrictcheckups
t
Atfemaletpatienttwhotwastinvolvedtintantautotaccidenttpresentsttotthetemergencytdepartmentt(ED)tfort
evaluation.tShetdoestnotthavetanytcomplaints.tThetprovidertevaluatesthertandtdeterminesttheretaretnot
injuries.tThetprovidertinformstthetpatientttotcometbackttotthetEDtortseethertprimarytcaretphysiciantiftsh
etdevelopstanytsymptoms.tHowtistthetclaimtprocessedtfortthistencounter?t
A.tThetmedicaltinsurancetistbilledtprimarytandtthetautotinsurancetistbilledtsecondary.t
B.tThetautotinsurancetistbilledtprimarytandtthetmedicaltinsurancetistbilledtsecondary.t
C.tBilltthetmedicaltinsurancetfirstttotreceivetatdenialtandtthentsubmittwithtthetremittancetadvicettottheta
utotinsurance.t
D.tBilltonlytthetmedicaltinsurancetbecausetthetautotinsurancetonlytcoverstdamagettotthetvehicle,tnottm
edicaltexpenses.t-t
✅B.tThetautotinsurancetistbilledtprimarytandtthetmedicaltinsurancetistbilledtsecondary.
t
Whattformstneedttotbetsubmittedtwhentbillingtfortatwork-relatedtinjury?
t
A.tProgresstreports,tandtWC-1500tclaimtformt
4t|tP a g e
