AAPC CPB Practice Exam Questions
and Answers89
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. - ANSWERS-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 - ANSWERS-C. II and IV
,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 - ANSWERS-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. - ANSWERS-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 - ANSWERS-B. TRICARE Prime
A Medicare card will list which of the following:
,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 - ANSWERS-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 - ANSWERS-B. II and III
, 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 - ANSWERS-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 - ANSWERS-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 - ANSWERS-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
and Answers89
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. - ANSWERS-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 - ANSWERS-C. II and IV
,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 - ANSWERS-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. - ANSWERS-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 - ANSWERS-B. TRICARE Prime
A Medicare card will list which of the following:
,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 - ANSWERS-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 - ANSWERS-B. II and III
, 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 - ANSWERS-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 - ANSWERS-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 - ANSWERS-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
