Download AAPC CPB - Chapter 3 Practical Application Exam Question & Answers 2025 and more Exams Nursing in PDF only on Docsity!
Exam Question & Answers 2025
Use the CPB Chapter 3_Case 1.pdf to answer questions 1 & 2.
- Susan smith arrives at her in-network primary care physician's office for her annual preventive visit. What is her copay? a. $15. b. $50. c. $75. d. The patient does not have a copay for preventive visits. - CORRECT ANSWER โโd. The patient does not have a copay for preventive visits. Response Feedback: On the insurance card, under the copay column for In-network, is N/A next to preventive. This indicates the patient does not have a copay for preventive services. Using CPB Chapter 3_Case 1.pdf from the prior question, answer: According to this insurance card, is Susan's husband, Eric Smith, covered by her insurance plan?
Exam Question & Answers 2025
a. Yes; Eric Smith is covered by her insurance plan. b. Yes; Susan Smith has full coverage for her entire family. c. No; Susan Smith is the only person covered by her plan. d. No; Susan Smith and her children are the only members of her family covered by her plan. - CORRECT ANSWER โโd. No; Susan Smith and her children are the only members of her family covered by her plan. Response Feedback: The bottom of Susan Smith's insurance card shows coverage includes Medical EMP/CH. This means she has medical coverage for her and her children. Use the CPB Chapter 3_Case 2.pdf to answer questions 3 & 4. Caroline's mom, Jessica, brings her to the office for hives. The providers are in network for both insurance companies involved. Caroline's mom and dad are married. Caroline is covered by both of their insurance policies. The insurance companies both use the birthday rule for coordination of benefits. Which insurance carrier is primary and why?
Exam Question & Answers 2025
d. 159753468 - CORRECT ANSWER โโb. 6578358- Response Feedback: Jessica's insurance is primary based on the birthday rule. The policy number on Jessica's card is 6578358. Jessica is 6578358-01 and Caroline is 6578358-02. Use the CPB Chapter 3_Case 3.pdf answer questions 5 & 6. Cristian's mom, Yvonne, brings him to the office for his yearly physical. The providers are in network for both insurance companies involved. Cristian's parents are married. Cristian is covered by both of their insurance policies. What is his copay for this visit? a. $ b. $ c. $ d. $35 - CORRECT ANSWER โโc. $ Response Feedback:
Exam Question & Answers 2025
It's important to perform insurance verification as some carriers do not charge copays for preventive services. Using CPB Chapter 3_Case 3.pdf from the prior question, answer: Cristian's mom, Yvonne, brings him to the office for an ear infection. The providers are in network for both insurance companies involved. Cristian's parents are married. Cristian is covered by both of their insurance policies. The insurance companies both use the birthday rule for coordination of benefits. What is his copay for this visit? a. $ b. $ c. $ d. $35 - CORRECT ANSWER โโa. $ Response Feedback: For coordination of benefits, many insurance carriers utilize the birthday rule. The birthday rule states that the person whose birthday falls earlier in the year, Cristian's father's birthday is May and his
Exam Question & Answers 2025
your system that his name is Robert, however for submission of the claim it must match the card. Review the card and provide the insurance ID for Joshua. a. H b. H c. H d. H1234567805 - CORRECT ANSWER โโd. H Response Feedback: When entering the patient ID, it's important to review the patient indicator that is listed next to the patient name. In this case we were entering the information for Joshua which is patient # 5 on the card. There is a total of 6 covered under this plan. Stacy's mom, Angela, brings her to the office for pain in left arm (it appears to be broken). Stacy has insurance with both parents (married - Angela and James). The providers are in network for both insurance companies involved. Using the birthday rule, which insurance carrier is primary and why?
Exam Question & Answers 2025
a. ABC Health Plan; Angela (mom) brought her to the office making her insurance primary for this visit. b. Concourse Health Plan: Angela's (mom) birthday occurs within the same year as James (dad) birthday. c. Concourse Health Plan; James' (dad) insurance was in effect prior to Angela's (mom) insurance. d. Concourse Health Plan; James' (dad) date of birth month and day is before Angela's (mom). - CORRECT ANSWER โโd. Concourse Health Plan; James' (dad) date of birth month and day is before Angela's (mom). Response Feedback: For coordination of benefits, many insurance carriers utilize the birthday rule. The birthday rule states that the person whose birthday falls earlier in the year, insurance will be primary. Concourse Health Plan is primary because dad's birthday falls earlier in the year. On 12/20/20XX, Mr. Smith had an appt with Dr. Taylor to discuss pain in his lower joint. During the visit, Dr. Taylor ordered a pain injection. No additional follow up or testing was done. Why is this encounter form considered incomplete?
Exam Question & Answers 2025
get an authorization for the mammogram. What number should the office call? a. (888) 555- b. (888) 555- c. (888) 555- d. (888) 555-7896 - CORRECT ANSWER โโd. (888) 555- Response Feedback: The office is calling for a prior authorization for a mammogram. The number listed on the back of the insurance card for pre-authorizations is 888-555-7896. Use Case 8 from the prior question to answer this question. The office calls ABC Health Plan and is unable to verify coverage based on the patient's demographics given. How should the office proceed? a. Review the patient's demographics and ensure all information is accurate.
Exam Question & Answers 2025
b. Call the patient to make correction to the patient's demographics and then attempt to verify coverage. c. Tell the patient that she has no coverage. d. Inform the patient of the error as the patient will need to pay for the service out of pocket. - CORRECT ANSWER โโb. Call the patient to make correction to the patient's demographics and then attempt to verify coverage. Response Feedback: The office should contact the patient to obtain the correct demographic information, then attempt to verify coverage again. Use this insurance card to answer questions 13 & 14. Joe sees his doctor regularly for diabetes management. His blood glucose level is a little higher than usual, so he goes to the Urgent Care Center for help in decreasing his blood glucose level. What is Joe's co- pay for the urgent care visit? a. $50. b. $75.
Exam Question & Answers 2025
Response Feedback: The patient pays 100% of the deductible amount. Once that has been met, cost of the visit/service is shared between the health plan, co- pays, coinsurance. Use the CPB Chapter 3 Case 9 PDF to answer questions 15 & 16. Verification of Benefits: Jonathan Rushmore Jonathan has a doctor's appointment with Dr. Bradley to discuss pain in his lower back. He has seen Dr. Bradley for back pain multiple times. Dr. Bradley refers him to a Chiropractor. Based on the verification of benefits, what is his co-pay for an In-Network Chiropractic Manipulation? a. $15. b. $25. c. $45. d. $500.00 - CORRECT ANSWER โโa. $15. Response Feedback:
Exam Question & Answers 2025
According to the verification of benefits, Jonathan's co-pay for an in- network chiropractic manipulation is $15.00. Use Case 10 from the prior question to answer this question: Jonathan receives chiropractic services for his back pain. After receiving five chiropractic treatments, Dr. Flores refers him to see a specialist. The pain is not improving, and surgery may be needed. What is Jonathan's responsibility when seen by an in-network specialist for the surgery? a. $15. b. $30. c. $45. d. $500.00 - CORRECT ANSWER โโc. $45. Response Feedback: According to the verification of benefits, Jonathan's co-pay for an in- network specialist surgery is $45.00.
