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CPB PRACTICE EXAM C, Questions and answers, 100% Accurate. Approved.
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CPB PRACTICE EXAM C, Questions and answers, 100% Accurate. Approved. A 6 year-old is seen in the pediatrician office for the first time. He has insurance coverage through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose insurance is primary? A. Mother's insurance plan B. ...

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  • February 8, 2023
  • 16
  • 2022/2023
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CPB PRACTICE EXAM C, Questions and
answers, 100% Accurate. Approved.

A 6 year-old is seen in the pediatrician office for the first time. He has insurance coverage through both
his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose insurance is primary?

A. Mother's insurance plan

B. Father's insurance plan

C. The policy that has the best benefits

D. Either mother's or father's insurance plan depending who brings the child in for medical care. - ✔✔-
The birthday rule states the parent whose birthday falls first in the year is primary. The year of birth is
not relevant. In this case, the mother's birthday falls before the father's birthday so the mother's
insurance is primary.



Which managed care plan has the patient receiving care from participating providers (network provider)
and the providers are only paid for services provided?

A. Health Maintenance Organization (HMO)

B. Point-of-Service Plan (POS)

C. Exclusive Provider Organization (EPO)

D. Integrated Delivery System (IDS) - ✔✔-EPO is a managed care plan in which enrollees must receive
their care from doctors and hospitals within the EPO network, but cannot go outside of the network for
care. If an enrollee goes to a provider or hospital outside of the network the enrollee will have to pay
the medical bills out of pocket. A network provider for EPO plans is reimbursed on fee-for-service basis.



Which TRICARE plan is similar to an HMO plan?

A. TRICARE Extra

B. TRICARE Standard

C. TRICARE Prime

D. TRICARE Premium - ✔✔-TRICARE Prime is one of the three healthcare options that is similar to an
HMO plan as the patient is assigned a PCP and the treatment goes through the PCP.

,Which of the services are covered by Medicare Part A?



I. Skilled Nursing Facility Care

II. Ambulatory Surgery

III. Durable Medical Equipment

IV. Hospice Care

V. Home Health Services

VI. Long Term Care

VII. Outpatient prescription drugs

A. I-VII

B. II, III, VI

C. I, II, IV, VII

D. I, IV, V - ✔✔-Medicare Part A covers hospital care, skilled nursing facility care, nursing home care,
hospice, and home health services.



Which is a TRUE statement regarding Workers' Compensation?

A. There is no copayment for the injured worker in workers' compensation cases.

B. The filing deadline for a first report of injury form is one week from the date of the accident.

C. Providers can balance bill a patient when compensation payment is not paid in full.

D. There is a deductible for the injured worker in workers' compensation claims. - ✔✔-There is no co-
payment for workers' compensation cases. A worker (employee) cannot be given a bill for co-pay or
anything else because it is the insurance policy of the employer, and not the workers' personal policy,
that pays the bill. The filing deadline for a first report of injury form is determined by state law. All
providers must accept the compensation payment as payment in full. There is no deductible in workers'
compensation.



Bob sees his family physician for seasonal allergies.Before leaving, Bob pays the charge for the office
visit. As a courtesy, the physician's staff submits a claim to Bob's insurance company. If the service is
covered by the insurance company, Bob can expect to be reimbursed for the office visit. This is which
type of insurance model?

A. Healthcare Anywhere

B. Managed Care Plan

, C. Fee-for-service (traditional coverage)

D. Health Maintenance Organization (HMO) - ✔✔-Blue Cross/Blue Shield fee-for-service (traditional
coverage) plan is selected by individuals who do not have the access to a group plan, and for small
business employers. The plan has two types of coverage, basic coverage and major medical benefits.



Which of the following benefits are NOT covered by all Medigap polices?



I. Part A co-insurance and hospital costs

II. Skilled nursing facility care co-insurance

III. Parts A & B deductible

IV. Part B excess charges

V. Foreign travel exchange

A. I, II, III

B. I, III

C. I, IV, V

D. II, III, IV, V - ✔✔-Medigap is required to cover Part A coinsurance and hospital costs. The remaining
items are only covered by some of the Medigap policies.



Medicaid eligibility is primarily determined by?

A. Income

B. Prior insurance coverage

C. Marital status

D. Number of living relatives - ✔✔-Medicaid eligibility is primarily determined by the patient's monthly
income.



____________ is incorporated by CMS into the NCCI program to limit the number of times a service or
procedure can be reported by a physician on the same date of service to a patient.

A. Outpatient Code Editor (OCE)

B. Medically Unlikely Edits (MUE)

C. Physician Fee Schedule

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