CMAA CMAA Comprehensive Review 3 — Questions and Answers
Question 1: A patient calls requesting a refill on a controlled substance. The medical administrative assistant should:
- Refill it immediately and document later
- Direct the patient to schedule an appointment with the provider (Correct answer)
- Contact the pharmacy directly to authorize the refill
- Advise the patient to obtain the medication from an urgent care
Correct answer: Direct the patient to schedule an appointment with the provider
Controlled substance refills require direct provider evaluation and cannot be authorized by administrative staff.
Question 2: Which form is used by Medicare patients to acknowledge they understand a service may not be covered?
- CMS-1500
- Advance Beneficiary Notice (ABN) (Correct answer)
- HIPAA Authorization Form
- Assignment of Benefits Form
Correct answer: Advance Beneficiary Notice (ABN)
An ABN is given to Medicare patients before a service that may be denied, so they understand financial responsibility.
Question 3: In medical billing, 'clean claim' refers to a claim that:
- Has been paid in full
- Contains no errors and can be processed without additional information (Correct answer)
- Has passed an audit review
- Was submitted within 24 hours of service
Correct answer: Contains no errors and can be processed without additional information
A clean claim is complete, accurate, and can be adjudicated without further information from the provider.
Question 4: Which of the following best describes the role of a medical administrative assistant regarding medication administration?
- They may administer oral medications with provider supervision
- They do not administer medications unless specifically licensed to do so (Correct answer)
- They can administer vaccines if trained
- They may dispense sample medications to patients
Correct answer: They do not administer medications unless specifically licensed to do so
Medical administrative assistants are not licensed to administer medications; that duty belongs to clinical staff.
Question 5: What does the abbreviation 'EOB' stand for in healthcare billing?
- End of Benefits
- Explanation of Benefits (Correct answer)
- Evidence of Billing
- Estimate of Balance
Correct answer: Explanation of Benefits
An EOB (Explanation of Benefits) is a statement from an insurer explaining what was paid, adjusted, and owed for a claim.
Question 6: A patient presents with a Medicare card and a secondary insurance card. Which insurance should be billed first?
- Secondary insurance
- Medicare (Correct answer)
- Whichever has a lower deductible
- The insurance with the most recent effective date
Correct answer: Medicare
Medicare is typically the primary payer unless the patient has employer-sponsored insurance through active employment.
Question 7: The process of verifying a patient's insurance eligibility before a visit is important primarily to:
- Determine the diagnosis code to use
- Avoid billing denials and inform patients of their financial responsibility (Correct answer)
- Select the correct CPT codes
- Calculate the provider's reimbursement rate
Correct answer: Avoid billing denials and inform patients of their financial responsibility
Pre-visit eligibility verification reduces claim denials and ensures patients are aware of copays, deductibles, and coverage limits.
CMAA CMAA Comprehensive Review 3
A patient calls requesting a refill on a controlled substance.
The medical administrative assistant should: