CMAA Certified Medical Administrative Assistant 5 — Questions and Answers
Question 1: When a patient calls to report a serious adverse reaction to a new medication, the FIRST action the medical administrative assistant should take is:
- Document the complaint in the patient chart
- Advise the patient to go to the ER immediately
- Interrupt the provider or nurse immediately (Correct answer)
- Schedule a follow-up appointment
Correct answer: Interrupt the provider or nurse immediately
Potential medical emergencies must be escalated immediately to a clinical staff member or provider rather than handled administratively.
Question 2: Which of the following is an example of a 'clean claim'?
- A claim missing the patient's date of birth
- A claim submitted with an expired authorization number
- A claim with all required fields accurately completed on first submission (Correct answer)
- A claim for a non-covered service
Correct answer: A claim with all required fields accurately completed on first submission
A clean claim contains all required, accurate information and passes all edits, allowing the payer to process it without requesting additional information.
Question 3: The medical term 'dyspnea' refers to:
- Difficulty swallowing
- Painful urination
- Difficulty breathing (Correct answer)
- Abnormal heart rhythm
Correct answer: Difficulty breathing
Dyspnea is the medical term for difficulty or labored breathing, often described by patients as shortness of breath.
Question 4: Which act requires that individuals with disabilities be given equal access to programs and services offered by entities receiving federal financial assistance?
- Americans with Disabilities Act (ADA)
- Section 504 of the Rehabilitation Act (Correct answer)
- HIPAA
- Civil Rights Act Title VI
Correct answer: Section 504 of the Rehabilitation Act
Section 504 of the Rehabilitation Act of 1973 prohibits discrimination against people with disabilities in programs receiving federal funding, predating the ADA.
Question 5: In medical billing, 'upcoding' refers to:
- Using modifiers to indicate a higher level of service was performed
- Billing for a more expensive service than was actually provided (Correct answer)
- Coding a procedure with the most specific available code
- Applying the correct E/M level based on documentation
Correct answer: Billing for a more expensive service than was actually provided
Upcoding is fraud involving intentional submission of codes for more expensive services than those actually rendered to receive higher reimbursement.
Question 6: A patient who is both Medicare and Medicaid eligible is called a:
- Crossover patient
- Dual-eligible beneficiary (Correct answer)
- Bridge patient
- Supplemental enrollee
Correct answer: Dual-eligible beneficiary
Individuals who qualify for both Medicare and Medicaid are officially called dual-eligible beneficiaries, with Medicare serving as primary payer.
Question 7: Which document grants a designated individual the legal authority to make healthcare decisions on behalf of a patient who is unable to do so?
- Living will
- Do-Not-Resuscitate (DNR) order
- Durable Power of Attorney for Healthcare (Correct answer)
- Informed consent form
Correct answer: Durable Power of Attorney for Healthcare
A Durable Power of Attorney for Healthcare (healthcare proxy) designates an agent to make medical decisions when the patient lacks decision-making capacity.
CMAA Certified Medical Administrative Assistant 5
When a patient calls to report a serious adverse reaction to a new medication, the FIRST action the medical administrative assistant should take is: