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AAPC CPB FINAL EXAM NEWEST 2025 ACTUAL
EXAM COMPLETE 250 QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+|BRAND
NEW!!
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. - .....ANSWER ...✔✔ D.
Joe, because his birth month and day are before Mary's
birth month and day.
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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 - .....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?
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A. $400
B. $500
C. $900
D. $1,600 - .....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. - .....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
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C. TRICARE For Life
D. TRICARE Young Adult - .....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 - .....ANSWER ...✔✔ B. I, IV
In which of the following scenarios is Medicare the
secondary payer?
AAPC CPB FINAL EXAM NEWEST 2025 ACTUAL
EXAM COMPLETE 250 QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+|BRAND
NEW!!
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. - .....ANSWER ...✔✔ D.
Joe, because his birth month and day are before Mary's
birth month and day.
,2|Page
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 - .....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?
,3|Page
A. $400
B. $500
C. $900
D. $1,600 - .....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. - .....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
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C. TRICARE For Life
D. TRICARE Young Adult - .....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 - .....ANSWER ...✔✔ B. I, IV
In which of the following scenarios is Medicare the
secondary payer?
