AAPC CPB TESTBANK QUESTIONS WITH
COMPLETE SOLUTIONS 2024 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 thebirthday rule, who carries the primary insurance for their
children for billing?
• Joe, because he is the male head of the household.
• Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd.
• Mary, because her birth year is before Joe's birth year.
• 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 birthmonth and day.
Which type of managed care insurance allows clients to self-refer to out-of-
network providers and pay a higher co-insurance/copay amount?
• HMO
• PPO
• EPO
• POS
• Capitation
• II
• IV
• II and IV
• II, III, and V Correct Answer: C. II and IV
A client 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 client 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 client's responsibility?
A. $400
B. $500
C. $900
,D. $1,600 Correct Answer: C. $900
When a nonparticipating provider files a claim for a client to BC/BS, how is the
payment processed?
• The payment is sent to the client and the client must pay the provider.
• The payment is sent to the provider if the provider agrees to accept assignment.
• The payment is sent to the provider regardless if he accepts assignment.
• The claim is not paid because the provider is not participating in the plan.
Correct Answer: A. The payment is sent to the client and the client must pay the
provider.
Which of the following TRICARE options is/are available to active duty service
members?
• TRICARE Select
• TRICARE Prime
• TRICARE For Life
• TRICARE Young Adult Correct Answer: B. TRICARE
Prime A Medicare card will list which of the following:
• Effective date of coverage
• Home address
• Telephone Number
• Entitled to Part A and/or Part B
• When coverage ends
• Name of Primary Care Physician
• I - VI
• I, IV
• I-III, VI
• I, II, IV, V Correct Answer: B. I, IV
In which of the following scenarios is Medicare the secondary payer?
• A 65 year-old client who is collecting her deceased spouse's Medicare
benefitsand has a supplemental insurance
,• A 72 year-old client who participates in the group health insurance of
hisemployer
• A 66 year-old client is injured at work and the employer does not offer
healthinsurance as a benefit of employment
• A 55 year-old client who is on disability through Social Security and
qualifies for Medicaid and Medicare
• I-IV
• II and III
• I and IV
• None Correct Answer: B. II and III
When a client 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?
• Plan name followed by "MEDIGAP"
• Plan Payer ID followed by "MEDIGAP"
• COBA Medigap claim-based identifier (ID)
• 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?
• Federal guidelines
• State guidelines
• Both A and B
• None Correct Answer: C. Both A and B
Which of the following services is covered by Early and Periodic Screening,
Diagnostic, and Treatment (EPSDT)?
• Family planning
• Obstetric care
• Pediatric checkups
• Emergency department visits Correct Answer: C. Pediatric checkups
A female client 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 client
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?
• The medical insurance is billed primary and the auto insurance is
billedsecondary.
• The auto insurance is billed primary and the medical insurance is
billedsecondary.
• Bill the medical insurance first to receive a denial and then submit with
theremittance advice to the auto insurance.
• Bill only the medical insurance because the auto insurance only covers
damageto 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?
• Progress reports, and WC-1500 claim form
• UB-04
• First Report of Injury form and an itemized statement
• First Report of Injury form, progress reports, and CMS-1500 claim form
Correct Answer: D. First Report of Injury form, progress reports, and CMS-
1500claim form
A document provided to Medicare clients explaining their financial
responsibilityif Medicare denies a service is a(n):
• Notice of Financial Liability
• Advance Beneficiary Notice
• Insurance waiver
• Explanation of Benefits Correct Answer: B. Advance Beneficiary
NoticeWhat is an Accountable Care Organization (ACO)?
• Groups of doctors, hospitals, and other health care providers who coordinate
high quality care to Medicare clients.
• An insurance carrier that provides a set fee based on the diagnosis of the client.
• A group of providers who contract with a third party administrator to pay fee
forservice for services.
COMPLETE SOLUTIONS 2024 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 thebirthday rule, who carries the primary insurance for their
children for billing?
• Joe, because he is the male head of the household.
• Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd.
• Mary, because her birth year is before Joe's birth year.
• 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 birthmonth and day.
Which type of managed care insurance allows clients to self-refer to out-of-
network providers and pay a higher co-insurance/copay amount?
• HMO
• PPO
• EPO
• POS
• Capitation
• II
• IV
• II and IV
• II, III, and V Correct Answer: C. II and IV
A client 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 client 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 client's responsibility?
A. $400
B. $500
C. $900
,D. $1,600 Correct Answer: C. $900
When a nonparticipating provider files a claim for a client to BC/BS, how is the
payment processed?
• The payment is sent to the client and the client must pay the provider.
• The payment is sent to the provider if the provider agrees to accept assignment.
• The payment is sent to the provider regardless if he accepts assignment.
• The claim is not paid because the provider is not participating in the plan.
Correct Answer: A. The payment is sent to the client and the client must pay the
provider.
Which of the following TRICARE options is/are available to active duty service
members?
• TRICARE Select
• TRICARE Prime
• TRICARE For Life
• TRICARE Young Adult Correct Answer: B. TRICARE
Prime A Medicare card will list which of the following:
• Effective date of coverage
• Home address
• Telephone Number
• Entitled to Part A and/or Part B
• When coverage ends
• Name of Primary Care Physician
• I - VI
• I, IV
• I-III, VI
• I, II, IV, V Correct Answer: B. I, IV
In which of the following scenarios is Medicare the secondary payer?
• A 65 year-old client who is collecting her deceased spouse's Medicare
benefitsand has a supplemental insurance
,• A 72 year-old client who participates in the group health insurance of
hisemployer
• A 66 year-old client is injured at work and the employer does not offer
healthinsurance as a benefit of employment
• A 55 year-old client who is on disability through Social Security and
qualifies for Medicaid and Medicare
• I-IV
• II and III
• I and IV
• None Correct Answer: B. II and III
When a client 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?
• Plan name followed by "MEDIGAP"
• Plan Payer ID followed by "MEDIGAP"
• COBA Medigap claim-based identifier (ID)
• 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?
• Federal guidelines
• State guidelines
• Both A and B
• None Correct Answer: C. Both A and B
Which of the following services is covered by Early and Periodic Screening,
Diagnostic, and Treatment (EPSDT)?
• Family planning
• Obstetric care
• Pediatric checkups
• Emergency department visits Correct Answer: C. Pediatric checkups
A female client 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 client
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?
• The medical insurance is billed primary and the auto insurance is
billedsecondary.
• The auto insurance is billed primary and the medical insurance is
billedsecondary.
• Bill the medical insurance first to receive a denial and then submit with
theremittance advice to the auto insurance.
• Bill only the medical insurance because the auto insurance only covers
damageto 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?
• Progress reports, and WC-1500 claim form
• UB-04
• First Report of Injury form and an itemized statement
• First Report of Injury form, progress reports, and CMS-1500 claim form
Correct Answer: D. First Report of Injury form, progress reports, and CMS-
1500claim form
A document provided to Medicare clients explaining their financial
responsibilityif Medicare denies a service is a(n):
• Notice of Financial Liability
• Advance Beneficiary Notice
• Insurance waiver
• Explanation of Benefits Correct Answer: B. Advance Beneficiary
NoticeWhat is an Accountable Care Organization (ACO)?
• Groups of doctors, hospitals, and other health care providers who coordinate
high quality care to Medicare clients.
• An insurance carrier that provides a set fee based on the diagnosis of the client.
• A group of providers who contract with a third party administrator to pay fee
forservice for services.
