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AAPC CPB Practice Exam A Questions and Answers
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AAPC CPB Practice Exam A Questions and Answers 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. J...

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  • October 30, 2024
  • 35
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • aapc cpb practice exam a questions and answers

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©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED

FIRST PUBLISH OCTOBER 2024




AAPC CPB Practice Exam A Questions

and Answers


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. - ANSWER✔✔-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.

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, ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED

FIRST PUBLISH OCTOBER 2024




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 - ANSWER✔✔-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



Page 2/35

, ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED

FIRST PUBLISH OCTOBER 2024




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 - ANSWER✔✔-ANSWER:




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?




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, ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED

FIRST PUBLISH OCTOBER 2024




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 - ANSWER✔✔-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


D. TRICARE Young Adult - ANSWER✔✔-ANSWER:




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