CMAA Comprehensive Review 2 — Questions and Answers
Question 1: Unique usernames and strong passwords in an EHR are which HIPAA Security Rule safeguard?
- Physical
- Technical (Correct answer)
- Administrative
- Organizational
Correct answer: Technical
User identification and passwords are technical safeguards involving technology-based access controls.
HIPAA Security Rule safeguards: administrative (policies, training), physical (facility security, device controls), technical (technology-based protections). Unique user ID is a required technical safeguard under Access Control. Others: automatic logoff, encryption, audit controls, integrity mechanisms.
Question 2: How does workers' compensation billing differ from standard insurance?
- No difference
- Billed to employer's workers' comp carrier; patient has no copay or deductible (Correct answer)
- Patient pays and is reimbursed
- Cannot be billed electronically
Correct answer: Billed to employer's workers' comp carrier; patient has no copay or deductible
Workers' comp claims go to the employer's carrier, not patient insurance. The employee typically has zero out-of-pocket costs.
Differences: billed to workers' comp carrier, no patient out-of-pocket, employer/carrier must authorize treatment, specific forms may be required (First Report of Injury), different fee schedules, diagnosis must relate to workplace injury, specific filing time limits. Maintain separate documentation.
Question 3: What did MACRA create in healthcare?
- Free healthcare for over-65
- The Quality Payment Program linking reimbursement to quality metrics (Correct answer)
- The original Medicare program
- Only children's insurance
Correct answer: The Quality Payment Program linking reimbursement to quality metrics
MACRA created the Quality Payment Program (QPP) tying Medicare reimbursement to quality and value measures.
QPP has two tracks: MIPS (adjusts payments based on quality, improvement activities, interoperability, and cost) and Advanced APMs (incentive payments for risk-bearing models). CMAAs impact: ensuring EHR meets requirements, documenting quality measures, tracking required data, and understanding payment dependence on accuracy.
Question 4: What should be included in a specialist referral?
- Only name and insurance
- Demographics, insurance, clinical reason, relevant history, diagnostic results, and referring provider info (Correct answer)
- Just the physician's letter
- Entire medical record from birth
Correct answer: Demographics, insurance, clinical reason, relevant history, diagnostic results, and referring provider info
A complete referral includes demographics, insurance/authorization, referral reason, relevant history, test results, and provider contacts.
Include: demographics, insurance with authorization if required, referral details (provider, reason, urgency), clinical info (diagnoses, history, medications, allergies), diagnostic results, and specific questions. Verify in-network status, obtain authorization, provide patient with specialist info.
Question 5: What is the difference between a deductible and a copayment?
- Same thing, different names
- Deductible is annual amount before insurance covers costs; copayment is fixed per-visit fee (Correct answer)
- Copayment is always higher
- Deductible only for hospitals; copay for offices
Correct answer: Deductible is annual amount before insurance covers costs; copayment is fixed per-visit fee
A deductible is the annual threshold before insurance pays; a copayment is a fixed fee at each visit regardless of deductible.
Deductible: annual out-of-pocket amount before insurance starts paying. Copay: fixed dollar amount per visit ($20-$50 typical). Coinsurance: percentage split after deductible (e.g., 80/20). Out-of-pocket maximum: annual cap on total patient spending. CMAAs must explain these and collect correctly.
Question 6: A data entry error is found in a billing record after claim submission. What should the CMAA do?
- Ignore it since the claim was sent
- Contact the payer/clearinghouse to correct or void, submit corrected claim, document the error (Correct answer)
- Wait for denial then fix
- Delete entire billing record
Correct answer: Contact the payer/clearinghouse to correct or void, submit corrected claim, document the error
Proactively contact the payer or clearinghouse to void or correct the claim, submit an accurate corrected claim, and document everything.
Determine the error's nature and impact, check if the clearinghouse can intercept, submit corrected claim with appropriate frequency code (7=replacement, 8=void), include original reference number, document in account notes, notify patient if balance affected, and review cause to prevent recurrence.
CMAA Comprehensive Review 2
Unique usernames and strong passwords in an EHR are which HIPAA Security Rule safeguard?