CMAA Certified Medical Administrative Assistant MCQ 4 — Questions and Answers
Question 1: A patient presents with a broken arm sustained at work. Which category of insurance would be the primary payer?
- The patient's personal health insurance
- Workers' compensation insurance (Correct answer)
- Medicare
- Medicaid
Correct answer: Workers' compensation insurance
Work-related injuries are covered by workers' compensation, which is primary over personal health insurance.
Question 2: Which ICD coding system is currently required for diagnosis coding in the United States?
- ICD-9-CM
- ICD-10-CM (Correct answer)
- ICD-11-CM
- DSM-5
Correct answer: ICD-10-CM
ICD-10-CM has been mandated for diagnosis coding in the US since October 1, 2015.
Question 3: What is the purpose of a prior authorization (pre-authorization) in healthcare?
- To obtain the patient's consent for treatment
- To get insurance approval before performing certain services or procedures (Correct answer)
- To verify that the patient has paid their co-pay
- To confirm that the referring physician is in-network
Correct answer: To get insurance approval before performing certain services or procedures
Prior authorization is an insurer's advance approval that a specific service or medication is medically necessary and covered.
Question 4: When a patient signs a release of information form, which element is NOT typically required for it to be valid under HIPAA?
- The name of the person or entity receiving the information
- The purpose for the disclosure
- The patient's Social Security Number (Correct answer)
- An expiration date or event
Correct answer: The patient's Social Security Number
HIPAA authorization forms require specific elements but do not mandate inclusion of the patient's Social Security Number.
Question 5: A medical administrative assistant discovers a billing error where a patient was overcharged. What is the correct next step?
- Ignore the error if it was already paid by insurance
- Document the error and notify the billing supervisor or practice manager immediately (Correct answer)
- Refund the patient without telling the provider
- Adjust the charge in the system without creating a paper trail
Correct answer: Document the error and notify the billing supervisor or practice manager immediately
Billing errors must be reported to the appropriate supervisor and corrected with proper documentation to maintain compliance.
Question 6: Which of the following best describes 'upcoding' in medical billing?
- Using the most specific diagnosis code available
- Billing for a higher-level service than was actually performed (Correct answer)
- Assigning multiple CPT codes for a complex procedure
- Reporting a code that was bundled into another service
Correct answer: Billing for a higher-level service than was actually performed
Upcoding is a fraudulent practice of billing for a more expensive service than was documented or provided.
Question 7: What does the acronym SOAP stand for in clinical documentation?
- Summary, Objective, Assessment, Plan
- Subjective, Objective, Assessment, Plan (Correct answer)
- Subjective, Observations, Analysis, Prescriptions
- Symptoms, Observations, Assessments, Procedures
Correct answer: Subjective, Objective, Assessment, Plan
SOAP notes structure clinical documentation as Subjective (patient's complaints), Objective (exam findings), Assessment (diagnosis), and Plan (treatment).
CMAA Certified Medical Administrative Assistant MCQ 4
A patient presents with a broken arm sustained at work.
Which category of insurance would be the primary payer?