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AAPC CPB Actual Exam Questions and Verified Answers (2024 / 2025) 100% Correct | Grade A+
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AAPC CPB Actual Exam Questions and Verified Answers (2024 / 2025) 100% Correct | Grade A+ 1. 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 in...

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  • September 5, 2024
  • 24
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • AAPC CPB
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AAPC CPB Actual Exam
Questions and Verified
Answers () 100%
Correct | Grade A+

1. 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
dayANSWER D. Joe, because his birth month and day are before Mary's birth
month and day.


2. Which type of managed care insurance allows clients 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


3. A client 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 client 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 client's
responsibility?


A. $400
B. $500
C. $900
D. $1,600 ANSWER C. $900


4. When a nonparticipating provider files a claim for a client to BC/BS,
how is the payment processed?

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