CMAA Financial Management and Accounting 2 — Questions and Answers
Question 1: What is a write-off (adjustment) in medical billing?
- A fee added for late payment
- An amount the practice agrees not to collect (Correct answer)
- A refund issued to a patient
- A charge submitted to insurance
Correct answer: An amount the practice agrees not to collect
A write-off is an adjustment that reduces the patient's balance by an amount the practice has agreed not to collect, often due to a contractual discount.
Question 2: Which form is used to submit claims to Medicare and most commercial insurers?
- UB-04
- CMS-1500 (Correct answer)
- ADA Dental Claim Form
- HCFA-99
Correct answer: CMS-1500
The CMS-1500 is the standard paper claim form used by non-institutional providers to bill Medicare, Medicaid, and most commercial insurers.
Question 3: What does 'aging report' refer to in a medical office?
- A list of elderly patients
- A report tracking outstanding balances by time period (Correct answer)
- A staff performance review
- A medication expiration log
Correct answer: A report tracking outstanding balances by time period
An aging report categorizes outstanding accounts receivable by how long balances have been unpaid (30, 60, 90, 120+ days).
Question 4: What is co-insurance in a health insurance plan?
- A fixed fee paid per visit
- The monthly insurance premium
- The percentage of costs shared between patient and insurer after the deductible (Correct answer)
- The maximum lifetime benefit
Correct answer: The percentage of costs shared between patient and insurer after the deductible
Co-insurance is the percentage of covered costs a patient pays after meeting the deductible, with the insurer paying the remainder.
Question 5: What does 'balance billing' mean?
- Billing the insurance company first
- Billing the patient for the difference between the provider's charge and the insurer's payment (Correct answer)
- Sending bills at the end of each month
- Balancing the daily transaction log
Correct answer: Billing the patient for the difference between the provider's charge and the insurer's payment
Balance billing occurs when a provider bills the patient for the difference between their charge and what the insurance company paid.
Question 6: Which payment method describes a set monthly fee paid per patient regardless of services used?
- Fee-for-service
- Capitation (Correct answer)
- Pay-for-performance
- Bundled payment
Correct answer: Capitation
Capitation is a payment model in which providers receive a fixed monthly fee per enrolled patient, regardless of how many services are rendered.
CMAA Financial Management and Accounting 2
What is a write-off (adjustment) in medical billing?