AAPC CPB FINAL EXAMINATION TEST 2026
FULL SOLVED QUESTIONS AND SOLUTIONS
◉ The Protecting Patients and Affordable Care Act (PPACA) is a
federal mandate which establishes that coverage can no longer be
denied for what reason?
A. Pre-existing conditions
B. Being unemployed
C. Having high medical costs
D. Having other coverage. Answer: A. Pre-existing conditions
Rationale: PPACA stipulates that coverage cannot be denied for pre-
existing conditions, maternity care, newborn care, mental health
services, and preventive care
◉ What is the largest health program in the United States?
A. Medicare
B. Medicaid
C. TRICARE
D. Blue Cross Blue Shield. Answer: A. Medicare
Rationale: Medicare is a social insurance program and covers over
63 million people. It is the largest health program in the United
States
,◉ What is an insurance plan that provides a gatekeeper to manage
the patient's healthcare?
A. PPO
B. HMO
C. Medicaid
D. IPO. Answer: B. HMO
Rationale: A gatekeeper or PCP is provided to manage the patient's
healthcare needs
◉ A Medicare beneficiary needing to fill a prescription would utilize
what Part of their Medicare benefits?
A. Part D
B. Part C
C. Part B
D. Part A. Answer: A. Part D
Rationale: Medicare Part D reimburses for prescription drugs
◉ Which of the following statements is TRUE regarding Medicare?
A. No premiums are charged for Part A if the beneficiary contributed
through the work force
B. A patient can participate in Part A, B, C, and D for Medicare
C. Medicare beneficiaries must be age 65 to qualify for coverage
,D. Beneficiaries are required to participate in Part B Medicare.
Answer: A. No premiums are charged for Part A if the beneficiary
contributed through the work force
Rationale: No premiums are charged for those that contributed
through the work force. Part C is for Medicare Advantage plans that
substitute for Part A and Part B traditional Medicare. Part B
Medicare is optional and requires a monthly premium. Medicare
coverage is extended for some individuals with disabilities, even if
they are not 65 years of age
◉ Medicare has 4 parts - which part is responsible for paying
hospital claims?
A. Part C
B. Part D
C. Part B
D. Part A. Answer: D. Part A
Rationale: Part A Medicare is responsible for paying Hospital claims.
Part B is for outpatient services, Part C for commercial Medicare
Advantage plans, and Part D for prescription drugs
◉ Which is NOT one of the types of coverage that TRICARE offers?
A. TRICARE for Life
B. TRICARE Prime®
C. TRICARE Premium
, D. TRICARE Select®. Answer: C. TRICARE Premium
Rationale: TRICARE offers coverage choices for health plans:
TRICARE Prime®, TRICARE Select®, TRICARE for Life, TRICARE
Reserve Select®, TRICARE Retired Reserve®, and TRICARE Young
Adult.
◉ A claim is denied stating the provider is not credentialed with the
commercial insurance. Which of the following would NOT be an
option for the practice?
A. Refile the claim under a credentialed provider in the group using
the group number
B. Verify the status of the provider's credentialing
C. Write-off the balance of the encounter
D. Bill the patient for the services. Answer: A. Refile the claim under
a credentialed provider in the group using the group number
Rationale: Billing the patient for services could be problematic if the
patient was told the provider was in-network and writingoff the
balance can create issues with providing free care but these could be
done. It would be appropriate to verify the credentialing as the claim
could have been processed incorrectly. It is NOT appropriate to bill
services to a provider that did not provide the care to the patient.
◉ Which type of HMO contracts with multiple specialty groups,
individual practice groups, and individual physicians?
A. Network Model HMO
FULL SOLVED QUESTIONS AND SOLUTIONS
◉ The Protecting Patients and Affordable Care Act (PPACA) is a
federal mandate which establishes that coverage can no longer be
denied for what reason?
A. Pre-existing conditions
B. Being unemployed
C. Having high medical costs
D. Having other coverage. Answer: A. Pre-existing conditions
Rationale: PPACA stipulates that coverage cannot be denied for pre-
existing conditions, maternity care, newborn care, mental health
services, and preventive care
◉ What is the largest health program in the United States?
A. Medicare
B. Medicaid
C. TRICARE
D. Blue Cross Blue Shield. Answer: A. Medicare
Rationale: Medicare is a social insurance program and covers over
63 million people. It is the largest health program in the United
States
,◉ What is an insurance plan that provides a gatekeeper to manage
the patient's healthcare?
A. PPO
B. HMO
C. Medicaid
D. IPO. Answer: B. HMO
Rationale: A gatekeeper or PCP is provided to manage the patient's
healthcare needs
◉ A Medicare beneficiary needing to fill a prescription would utilize
what Part of their Medicare benefits?
A. Part D
B. Part C
C. Part B
D. Part A. Answer: A. Part D
Rationale: Medicare Part D reimburses for prescription drugs
◉ Which of the following statements is TRUE regarding Medicare?
A. No premiums are charged for Part A if the beneficiary contributed
through the work force
B. A patient can participate in Part A, B, C, and D for Medicare
C. Medicare beneficiaries must be age 65 to qualify for coverage
,D. Beneficiaries are required to participate in Part B Medicare.
Answer: A. No premiums are charged for Part A if the beneficiary
contributed through the work force
Rationale: No premiums are charged for those that contributed
through the work force. Part C is for Medicare Advantage plans that
substitute for Part A and Part B traditional Medicare. Part B
Medicare is optional and requires a monthly premium. Medicare
coverage is extended for some individuals with disabilities, even if
they are not 65 years of age
◉ Medicare has 4 parts - which part is responsible for paying
hospital claims?
A. Part C
B. Part D
C. Part B
D. Part A. Answer: D. Part A
Rationale: Part A Medicare is responsible for paying Hospital claims.
Part B is for outpatient services, Part C for commercial Medicare
Advantage plans, and Part D for prescription drugs
◉ Which is NOT one of the types of coverage that TRICARE offers?
A. TRICARE for Life
B. TRICARE Prime®
C. TRICARE Premium
, D. TRICARE Select®. Answer: C. TRICARE Premium
Rationale: TRICARE offers coverage choices for health plans:
TRICARE Prime®, TRICARE Select®, TRICARE for Life, TRICARE
Reserve Select®, TRICARE Retired Reserve®, and TRICARE Young
Adult.
◉ A claim is denied stating the provider is not credentialed with the
commercial insurance. Which of the following would NOT be an
option for the practice?
A. Refile the claim under a credentialed provider in the group using
the group number
B. Verify the status of the provider's credentialing
C. Write-off the balance of the encounter
D. Bill the patient for the services. Answer: A. Refile the claim under
a credentialed provider in the group using the group number
Rationale: Billing the patient for services could be problematic if the
patient was told the provider was in-network and writingoff the
balance can create issues with providing free care but these could be
done. It would be appropriate to verify the credentialing as the claim
could have been processed incorrectly. It is NOT appropriate to bill
services to a provider that did not provide the care to the patient.
◉ Which type of HMO contracts with multiple specialty groups,
individual practice groups, and individual physicians?
A. Network Model HMO
