AAPC CPB - Practice Exam C
1. A 6 year-old is seen in the pediatrician office for the first time. He has
insurance coverage through both his mother (DOB 02/08/86 and his father
(DOB 05/15/85). Whose insurance is primary?
A. Mother's insurance plan
B. Father's insurance plan
C. The policy that has the best benefits
D. Either mother's or father's insurance plan depending who brings the
child in for medical care. (answer) A. Mother's insurance plan
2. Which managed care plan has the patient receiving care from
participating providers (network provider) and the providers are only paid
for services provided?
A. Health Maintenance Organization (HMO)
B. Point-of-Service Plan (POS)
C. Exclusive Provider Organization (EPO)
D. Integrated Delivery System (IDS) (answer) C. Exclusive Provider
Organization (EPO)
3. Which TRICARE plan is similar to an HMO plan?
A. TRICARE For Life
B. TRICARE Select
C. TRICARE Prime
D. TRICARE Young Adult (answer) C. TRICARE Prime
4. Which of the services are covered by Medicare Part A?
I. Skilled Nursing Facility Care
II. Ambulatory Surgery
III. Durable Medical Equipment
IV. Hospice Care
,V. Home Health Services
VI. Long Term Care
VII. Outpatient prescription drugs
A. I-VII
B. II, III, VI
C. I, II, IV, VII
D. I, IV, V (answer) D. I, IV, V
, 5. Which is a TRUE statement regarding Workers' Compensation?
A. There is no copayment for the injured worker in workers'
compensation cases.
B.The filing deadline for a first report of injury form is one week from the
date of the accident.
C. Providers can balance bill a patient when compensation payment is
not paid in full.
D. There is a deductible for the injured worker in workers' compensation
claims. (answer) A. There is no copayment for the injured worker in
workers' compensation cases.
6. Bob sees his family physician for seasonal allergies. Before leaving,
Bob pays the charge for the office visit. As a courtesy, the physician's staff
submits a claim to Bob's insurance company. If the service is covered by
the insurance company, Bob can expect to be reimbursed for the office
visit. This is which type of insurance model?
A. Healthcare Anywhere
B. Managed Care Plan
C. Fee-for-service (traditional coverage)
D. Health Maintenance Organization (HMO) (answer) C. Fee-for-service
(traditional cov- erage)
7. Which of the following benefits are NOT covered by all Medigap
policies?
I. Part A co-insurance and hospital costs
II. Skilled nursing facility care co-insurance
III. Parts A & B deductible
IV. Part B excess charges
V. Foreign travel exchange
A. I, II, III
B. I, III
C. I, IV, V
D. II, III, IV, V (answer) D. II, III, IV, V
1. A 6 year-old is seen in the pediatrician office for the first time. He has
insurance coverage through both his mother (DOB 02/08/86 and his father
(DOB 05/15/85). Whose insurance is primary?
A. Mother's insurance plan
B. Father's insurance plan
C. The policy that has the best benefits
D. Either mother's or father's insurance plan depending who brings the
child in for medical care. (answer) A. Mother's insurance plan
2. Which managed care plan has the patient receiving care from
participating providers (network provider) and the providers are only paid
for services provided?
A. Health Maintenance Organization (HMO)
B. Point-of-Service Plan (POS)
C. Exclusive Provider Organization (EPO)
D. Integrated Delivery System (IDS) (answer) C. Exclusive Provider
Organization (EPO)
3. Which TRICARE plan is similar to an HMO plan?
A. TRICARE For Life
B. TRICARE Select
C. TRICARE Prime
D. TRICARE Young Adult (answer) C. TRICARE Prime
4. Which of the services are covered by Medicare Part A?
I. Skilled Nursing Facility Care
II. Ambulatory Surgery
III. Durable Medical Equipment
IV. Hospice Care
,V. Home Health Services
VI. Long Term Care
VII. Outpatient prescription drugs
A. I-VII
B. II, III, VI
C. I, II, IV, VII
D. I, IV, V (answer) D. I, IV, V
, 5. Which is a TRUE statement regarding Workers' Compensation?
A. There is no copayment for the injured worker in workers'
compensation cases.
B.The filing deadline for a first report of injury form is one week from the
date of the accident.
C. Providers can balance bill a patient when compensation payment is
not paid in full.
D. There is a deductible for the injured worker in workers' compensation
claims. (answer) A. There is no copayment for the injured worker in
workers' compensation cases.
6. Bob sees his family physician for seasonal allergies. Before leaving,
Bob pays the charge for the office visit. As a courtesy, the physician's staff
submits a claim to Bob's insurance company. If the service is covered by
the insurance company, Bob can expect to be reimbursed for the office
visit. This is which type of insurance model?
A. Healthcare Anywhere
B. Managed Care Plan
C. Fee-for-service (traditional coverage)
D. Health Maintenance Organization (HMO) (answer) C. Fee-for-service
(traditional cov- erage)
7. Which of the following benefits are NOT covered by all Medigap
policies?
I. Part A co-insurance and hospital costs
II. Skilled nursing facility care co-insurance
III. Parts A & B deductible
IV. Part B excess charges
V. Foreign travel exchange
A. I, II, III
B. I, III
C. I, IV, V
D. II, III, IV, V (answer) D. II, III, IV, V
