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AAPC CPB Practice Exam/459 Questions with complete Solutions
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AAPC CPB Practice Exam/459Questions with complete Solutions
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. - -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 - -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 - -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.
- -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 - -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 - -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 - -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 - -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 - -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 - -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. - -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 - -
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 - -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. - -A. Groups of
doctors, hospitals, and other health care providers who coordinate high
quality care to Medicare patients.
-A new patient presents for her annual exam and has no complaints. She is
scheduled to see the physician assistant (PA). How should services be
billed ?
A. Bill under the PA.
B. A new patient can be billed incident to the physician.
C. The PA cannot see new patients.
D. Reschedule the patient with the physician - -A. Bill under the PA.
-CPT® codes 12032 and 12001 were reported together for a 2.6 cm
intermediate repair of a laceration to the right arm and a 2.5 cm simple
repair of a laceration to the left arm. 12001 was denied as a bundled service.
What action should be taken by the biller (following the CPT® guidelines)?
A. Write-off the charge for 12001 as it is a bundled procedure.
B. Resubmit a corrected claim as 12032, 12001-59.
C. Transfer the charge to patient responsibility.
D. Resubmit a corrected claim as 12032, 12001-51. - -B. Resubmit a
corrected claim as 12032, 12001-59.
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