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AAPC CPB Practice Exam A With Complete Solutions
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AAPC CPB Practice Exam A With Complete Solutions
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Q&AAAPC CPB Practice Exam A With
Complete Solutions
Joe and Mary are a married couple, and both carry insurance from their
employers. Joe was born on February 23, 1987 and Mary was born on April
4, 1984. 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 DOB is the 4th and Joe's DOB 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. - Answers ANSWER:
D - the birthday rule is used to determine coverage by primary and
secondary policies when each parent subscribes to a different health
insurance plan. the policy holder whose birth month and day occurs earlier
in the calendar year holds the primary policy when each parent subscribes
to a different health insurance plan.
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
, Q&A
III. EPO
IV. POS
V. Capitation
A. II
B. IV
C. II and IV
D. II, III, and V - Answers ANSWER:
C - Point-of-Service Plan (POS) and Preferred Provider Organization
(PPO) allow patients the flexibility to self-refer to a specialist instead of
requiring a referral from a primary care provider. A patient is required to
pay a higher deductible, co-insurance, or co-payment amount when he/she
sees an out-of-network provider
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 - Answers ANSWER:
, Q&A
C - The contracted rate is $2500. The patient must pay the deductible
($500) and 20% of $2,000 ($400). The total patient responsibility is $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 of if he accepts
assignment.
D. The claim is not paid because the provider is not participating in the plan
- Answers ANSWER:
A - Even when nonparticipating providers with BC/BS agree to submit the
claim for the patient or accept assignment, BC/BS sends the payment to
the patient. The patient is responsible for paying 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
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