AAPC CPB Test Bank Questions With
Complete Solutions 2023| GRADED A
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. Correct Answer: 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 Correct Answer: 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 Correct Answer: 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. Correct Answer: 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 Correct Answer: 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 Correct Answer: 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 Correct Answer: 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 Correct 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 Correct 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 Correct 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. Correct 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
Correct 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 Correct 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. Correct
Answer: A. Groups of doctors, hospitals, and other health care providers
who coordinate high quality care to Medicare patients.
Complete Solutions 2023| GRADED A
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. Correct Answer: 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 Correct Answer: 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 Correct Answer: 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. Correct Answer: 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 Correct Answer: 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 Correct Answer: 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 Correct Answer: 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 Correct 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 Correct 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 Correct 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. Correct 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
Correct 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 Correct 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. Correct
Answer: A. Groups of doctors, hospitals, and other health care providers
who coordinate high quality care to Medicare patients.
