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AAPC CPB - PRACTICE EXAM B 2024/2025
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AAPC CPB - PRACTICE EXAM B 2024/2025
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AAPC CPB - PRACTICE EXAM B2024/2025
What is the term for the total amount of covered medical expenses a policyholder must pay each year
out-of-pocket before the health insurance company begins to pay any benefits?
A. Copayment
B. Deductible
C. Secondary Payment
D. Coinsurance - Precise Answer ✔✔B. Deductible
Which type of insurance covers physicians and other healthcare professionals for liability as to claims
arising from patient treatment?
A. Business liability
B. Bonding
C. Medical malpractice
D. Workers' compensation - Precise Answer ✔✔C. Medical malpractice
Which of the following does NOT fall under group policy insurance?
I. The premium is paid for by the employee.
II. The premium is paid for (or partially paid for) by an employer.
III. The employer selects the plan(s) to offer to employees.
IV. Physical exams and medical history questionnaires are a mandatory part of the application process.
V. Employee can make changes to the policy.
VI. The employee's spouse and children are not eligible for coverage.
, A. III, IV, and V
B. II, III, and VI
C. II, IV, and V
D. I, IV, V, and VI - Precise Answer ✔✔D. I, IV, V, and VI
Dr. Wallace is in a capitation contract with Belleview Managed Care Health Plan. He received $25,000
from the health plan to provide services for the 175 enrollees on the health plan. The services provided
by Dr. Wallace to the enrollees cost $23,000. Based on the information, what must be done?
A. Dr. Wallace can keep the $2,000 profit under the terms of the capitated plan.
B. Dr. Wallace experienced a loss under the capitated plan and will need to pay $2,000 to the health
plan.
C. Dr. Wallace will need to payout the $2,000 to the 175 enrollees.
D. Dr. Wallace is required to put the $2,000 in a mutual fund. - Precise Answer ✔✔A. Dr. Wallace can
keep the $2,000 profit under the terms of the capitated plan.
What is the deadline for filing a Medicare claim?
A. One year from the date of service
B. 30 days from the date of service
C. 90 days from the date of service
D. Two years from the date of service - Precise Answer ✔✔A. One year from the date of service
A provider sees a patient who has TRICARE Select. The provider is not contracted with TRICARE but is
certified by the regional TRICARE Managed Care Support Contractor (MCSC). The provider charges $200
for the office visit. TRICARE allows $160 and pays $140. How much can the provider bill the patient for?
A. $0.00
B. $20.00
C. $60.00
D. $160.00 - Precise Answer ✔✔C. $60.00
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