CMAA CMAA Comprehensive Review 5 — Questions and Answers
Question 1: The term 'superbill' in a medical office refers to:
- An unusually large patient invoice
- A charge slip listing services rendered, diagnosis codes, and procedure codes used for billing (Correct answer)
- A summary of a patient's annual healthcare costs
- A bill sent to a secondary insurance after primary denial
Correct answer: A charge slip listing services rendered, diagnosis codes, and procedure codes used for billing
A superbill (also called an encounter form) is a pre-printed or electronic document capturing all billable information from a patient visit.
Question 2: Which federal law prohibits physicians from referring patients to facilities in which they have a financial interest?
- HIPAA
- Stark Law (Physician Self-Referral Law) (Correct answer)
- COBRA
- The False Claims Act
Correct answer: Stark Law (Physician Self-Referral Law)
The Stark Law prohibits physician self-referrals to entities with which the physician has a financial relationship, for designated health services.
Question 3: A patient requests copies of their medical records. Under HIPAA, the practice must provide access within:
- 7 business days
- 30 days (with one 30-day extension if needed) (Correct answer)
- 48 hours
- 60 days without exception
Correct answer: 30 days (with one 30-day extension if needed)
HIPAA requires covered entities to provide patients access to their PHI within 30 days, with a possible 30-day extension.
Question 4: Which type of insurance covers employees who are injured while performing job duties?
- COBRA
- Workers' Compensation (Correct answer)
- Medicaid
- Medigap
Correct answer: Workers' Compensation
Workers' compensation is a state-mandated insurance program that covers medical expenses and lost wages for work-related injuries.
Question 5: An ICD-10-CM code is used in medical billing to describe:
- The procedure or service performed
- The patient's diagnosis or reason for the visit (Correct answer)
- The provider's specialty
- The type of insurance plan
Correct answer: The patient's diagnosis or reason for the visit
ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) codes classify diagnoses and health conditions.
Question 6: What is the purpose of a prior authorization in healthcare?
- To confirm a patient's identity before treatment
- To obtain insurer approval before certain services or medications are provided (Correct answer)
- To authorize a provider to accept new patients
- To verify a patient's eligibility on the date of service
Correct answer: To obtain insurer approval before certain services or medications are provided
Prior authorization (pre-authorization) requires a provider to get insurer approval before delivering specific services to ensure coverage.
Question 7: When handling a medical emergency in the office, the medical administrative assistant's first priority should be to:
- Collect the patient's insurance information
- Alert clinical staff and call 911 if needed (Correct answer)
- Document the incident in the patient's chart
- Notify the practice manager
Correct answer: Alert clinical staff and call 911 if needed
Patient safety is the immediate priority; alerting clinical staff and activating emergency services takes precedence over administrative tasks.
CMAA CMAA Comprehensive Review 5
The term 'superbill' in a medical office refers to: