AAPC CPB FINAL ACTUAL EXAM QUESTIONS WITH
COMPLETE SOLUTIONS GUARANTEED PASS BRAND NEW
2025/2026
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
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
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.
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?
COMPLETE SOLUTIONS GUARANTEED PASS BRAND NEW
2025/2026
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
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
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.
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?
