AAPC CPB Practice Exam

AAPC CPB Practice Exam

• 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?

• 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. >>>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

• Capitation 1 / 4

• II
• IV
• II and IV
• II, III, and V >>>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 con- tracted rate for the procedure is $2,500. What is the patient's responsibility?

A. $400

B. $500

C. $900

• $1,600 >>>C. $900

• When a nonparticipating provider files a claim for a patient to BC/BS, how

is the payment processed? 2 / 4

• The payment is sent to the patient and the patient 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. >>>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?

• TRICARE Select
• TRICARE Prime
• TRICARE For Life
• TRICARE Young Adult >>>B. TRICARE Prime

• A Medicare card will list which of the following
• Effective date of coverage

II. Home address III. Telephone Number IV. Entitled to Part A and/or Part B

• When coverage ends

VI. Name of Primary Care Physician

A. I - VI 3 / 4

B. I, IV

C. I-III, VI

• I, II, IV, V >>>B. I, IV

• In which of the following scenarios is Medicare the secondary payer?

• 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

• I-IV
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