CMAA Certified Medical Administrative Assistant 4 — Questions and Answers
Question 1: When verifying a patient's insurance eligibility before an appointment, which information is LEAST critical to confirm?
- Policy effective dates
- Copay and deductible amounts
- The patient's date of birth
- The patient's preferred pharmacy (Correct answer)
Correct answer: The patient's preferred pharmacy
The patient's preferred pharmacy is pharmacy-related information irrelevant to medical office insurance eligibility verification.
Question 2: Which form is used to transfer financial responsibility for Medicare-covered services from Medicare to a secondary insurer?
- CMS-1450 (UB-04)
- CMS-1500
- MSP Questionnaire (Correct answer)
- ABN (Advance Beneficiary Notice)
Correct answer: MSP Questionnaire
The Medicare Secondary Payer (MSP) Questionnaire identifies whether another insurer is primary, determining the correct billing order.
Question 3: An 'encounter form' (superbill) in a medical office primarily serves to:
- Document the patient's consent for treatment
- Capture diagnosis and procedure codes for billing at the point of care (Correct answer)
- Record vital signs and chief complaint
- Authorize specialist referrals
Correct answer: Capture diagnosis and procedure codes for billing at the point of care
The superbill or encounter form captures the ICD and CPT codes used during a visit, serving as the source document for claim submission.
Question 4: Under OSHA's Bloodborne Pathogens Standard, all used sharps must be:
- Recapped before disposal
- Placed in a labeled, puncture-resistant sharps container (Correct answer)
- Wrapped in gauze and placed in regular trash
- Returned to the pharmacy for disposal
Correct answer: Placed in a labeled, puncture-resistant sharps container
OSHA requires used sharps to be disposed of in closeable, puncture-resistant, leak-proof, and labeled biohazard containers.
Question 5: The 'birthday rule' in insurance coordination of benefits determines:
- When a child ages off a parent's plan
- Which parent's plan is primary when a child is covered by both (Correct answer)
- The renewal date of a group health plan
- The deadline for filing a claim
Correct answer: Which parent's plan is primary when a child is covered by both
The birthday rule states that when a child is covered under both parents' insurance, the plan of the parent whose birthday falls earliest in the calendar year is primary.
Question 6: Which scheduling system assigns specific appointment time slots to specific types of visits to maximize provider efficiency?
- Wave scheduling
- Stream scheduling
- Cluster scheduling (Correct answer)
- Open-access scheduling
Correct answer: Cluster scheduling
Cluster scheduling groups similar types of appointments (e.g., all physical exams) together at certain times, improving workflow efficiency.
Question 7: A Coordination of Benefits (COB) clause prevents:
- Patients from changing insurance carriers mid-year
- Double payment exceeding 100% of actual charges (Correct answer)
- Providers from balance-billing Medicare patients
- Employees from waiving employer-sponsored coverage
Correct answer: Double payment exceeding 100% of actual charges
COB provisions ensure that when a patient has multiple insurance plans, combined payments cannot exceed the total amount of the actual medical charges.
CMAA Certified Medical Administrative Assistant 4
When verifying a patient's insurance eligibility before an appointment, which information is LEAST critical to confirm?