CCMA Administrative Duties 5 — Questions and Answers
Question 1: A medical assistant receives a subpoena for a patient's medical records. What is the correct response?
- Immediately send copies of all records to the requesting attorney
- Notify the physician and the practice's legal counsel before taking any action (Correct answer)
- Refuse to release any records since it violates HIPAA
- Ask the patient if they want their records released
Correct answer: Notify the physician and the practice's legal counsel before taking any action
A subpoena is a legal document that requires a formal response; the physician and legal counsel must be notified to ensure proper compliance procedures are followed.
Question 2: What is the purpose of an Explanation of Benefits (EOB) document?
- To notify the patient of their upcoming appointment details
- To explain how an insurance claim was processed and what the patient owes (Correct answer)
- To list the medications covered under a patient's plan
- To authorize a patient for a referral to a specialist
Correct answer: To explain how an insurance claim was processed and what the patient owes
An EOB is sent by the insurance company detailing what was billed, what was allowed, what was paid, and the patient's remaining responsibility.
Question 3: Which ICD coding system is currently used in the United States for diagnoses on medical claims?
- ICD-9-CM
- ICD-10-CM (Correct answer)
- ICD-11
- DSM-5
Correct answer: ICD-10-CM
The United States mandated the transition to ICD-10-CM for diagnosis coding on October 1, 2015, and it remains the current standard.
Question 4: A patient without insurance asks about the cost of a routine office visit before their appointment. What is the best approach?
- Decline to discuss fees as that is the billing department's role only
- Provide the self-pay fee schedule and inform them of any payment plan options (Correct answer)
- Tell the patient the cost will be determined after the visit
- Suggest the patient go to an urgent care center instead
Correct answer: Provide the self-pay fee schedule and inform them of any payment plan options
Providing transparent pricing and payment options helps uninsured patients make informed decisions and improves collections for the practice.
Question 5: What is the primary purpose of maintaining a 'tickler file' in a medical office?
- To store patient humor preferences for better rapport
- To track follow-up tasks and time-sensitive items that need future attention (Correct answer)
- To file insurance denials that have been appealed
- To log incoming faxes and correspondence by date received
Correct answer: To track follow-up tasks and time-sensitive items that need future attention
A tickler file is a chronological reminder system used to flag tasks, follow-ups, and deadlines that need attention on specific future dates.
Question 6: When a check is received from an insurance company, what is the proper first step in processing it?
- Deposit the check immediately into the practice bank account
- Post the payment to the patient's account and reconcile it with the EOB (Correct answer)
- Contact the insurance company to confirm the amount is correct
- Apply the payment to the oldest outstanding balance for that patient
Correct answer: Post the payment to the patient's account and reconcile it with the EOB
Payments must be posted to the correct patient account and reconciled against the EOB before depositing to ensure accurate accounts receivable records.
Question 7: A medical assistant discovers a coding error that resulted in the practice being overpaid by an insurance company. What should they do?
- Keep the overpayment since insurance companies routinely underpay
- Report the overpayment to the supervisor and return the funds to the insurer (Correct answer)
- Apply the overpayment as a credit toward the patient's future visits
- Wait to see if the insurer requests the money back before taking action
Correct answer: Report the overpayment to the supervisor and return the funds to the insurer
Retaining known overpayments from insurance companies is considered fraud; the practice must report and return any overpayments promptly.
CCMA Administrative Duties 5
A medical assistant receives a subpoena for a patient's medical records.
What is the correct response?