CMAA - Certified Medical Administrative Assistant Comprehensive Review 1 — Questions and Answers
Question 1: A patient calls to dispute a charge on their Explanation of Benefits (EOB). Which document should the medical administrative assistant reference first to verify the billed service?
- The patient's insurance card
- The superbill or encounter form from the visit (Correct answer)
- The provider's credentialing file
- The office's fee schedule master list
Correct answer: The superbill or encounter form from the visit
The superbill (encounter form) is the source document that captures the diagnosis and procedure codes billed for a specific visit, making it the first reference when verifying or disputing a charge.
Question 2: Under HIPAA's Minimum Necessary Standard, a medical administrative assistant should:
- Share the complete medical record whenever another provider requests it
- Disclose only the amount of protected health information needed to accomplish the purpose (Correct answer)
- Obtain written authorization before releasing any information to the patient
- Allow all staff members full access to patient records for efficiency
Correct answer: Disclose only the amount of protected health information needed to accomplish the purpose
The Minimum Necessary Standard requires covered entities to limit PHI disclosures to the least amount needed to fulfill the intended purpose, reducing unnecessary exposure of patient information.
Question 3: When scheduling a new patient appointment, which information is MOST critical to collect at the time of booking?
- Patient's employment history and salary
- Insurance information, reason for visit, and referring provider if applicable (Correct answer)
- Patient's preferred pharmacy and medication list
- A copy of the patient's previous lab results
Correct answer: Insurance information, reason for visit, and referring provider if applicable
Insurance information, the reason for visit, and referral details are essential at booking to verify eligibility, allocate appropriate appointment time, and ensure proper authorization before the visit occurs.
Question 4: Which of the following best describes the purpose of an Advance Beneficiary Notice (ABN)?
- It authorizes Medicare to pay the provider directly
- It informs the patient that Medicare may not cover a service and they may be financially responsible (Correct answer)
- It grants the provider permission to bill a secondary insurer
- It documents a patient's consent to receive treatment
Correct answer: It informs the patient that Medicare may not cover a service and they may be financially responsible
An ABN is a notice given to Medicare beneficiaries before a service is provided when the provider believes Medicare is unlikely to pay, so the patient can decide whether to proceed knowing they may owe the cost.
Question 5: A medical office receives a subpoena for a patient's medical records. What is the MOST appropriate first step?
- Immediately fax the records to the requesting attorney
- Notify the treating physician and consult the practice's legal counsel or compliance officer (Correct answer)
- Deny the request because it violates HIPAA
- Ask the patient to pick up their records and deliver them personally
Correct answer: Notify the treating physician and consult the practice's legal counsel or compliance officer
A subpoena is a legal document that requires careful handling; the physician and legal or compliance staff must review it to determine whether a court order or patient authorization is also required before releasing records.
Question 6: In ICD-10-CM coding, the convention 'Code first underlying disease' instructs the coder to:
- Assign only the manifestation code and omit the underlying condition
- Sequence the etiology (underlying disease) code before the manifestation code (Correct answer)
- Use the manifestation code as the principal diagnosis in all settings
- Query the physician before assigning any diagnosis code
Correct answer: Sequence the etiology (underlying disease) code before the manifestation code
When a condition has both an underlying etiology and a manifestation, ICD-10-CM instructs coders to list the etiology code first, followed by the manifestation code, to accurately reflect the cause-and-effect relationship.
CMAA - Certified Medical Administrative Assistant Comprehensive Review 1
A patient calls to dispute a charge on their Explanation of Benefits (EOB).
Which document should the medical administrative assistant reference first to verify the billed service?