CMAA (Certified Medical Administrative Assistant) Exam — Questions and Answers

Question 1: What is the standard retention period for adult patient medical records under most US state guidelines?

5 to 10 years after last visit or last date of service (Correct answer)
1 year after last visit
3 years after last visit
Records must be kept permanently

Correct answer: 5 to 10 years after last visit or last date of service

Most states require adult medical records to be retained for 5 to 10 years from the date of last service, though requirements vary by state.

Question 2: What is a common-used analgesic?

atenolol.
penicillin.
acetaminophen. (Correct answer)
furosemide

Correct answer: acetaminophen.

Acetaminophen (Tylenol) is a typical analgesic. Analgesics are pharmaceuticals that are used to treat pain. They can be either over-the-counter (acetaminophen and ibuprofen) or prescription (codeine and morphine). For mild to moderate pain and to reduce fever, acetaminophen is frequently recommended. If dosing instructions are followed, the medication is often safe for both adults and children. The liver may be harmed by an acetaminophen overdose.

Question 3: A claim is denied for 'lack of medical necessity.' What should the CMAA do?

Accept denial and bill the patient
Review denial, gather supporting documentation, and file an appeal (Correct answer)
Tell patient the practice can't help
Resubmit the same claim unchanged

Correct answer: Review denial, gather supporting documentation, and file an appeal

Review the denial reason, work with clinical team for supporting documentation, and file a formal appeal within the payer's deadline.

Question 4: What does the ADA require of a medical office?

Home visits for patients who cannot travel
Priority scheduling for all disabled patients
Reasonable accommodations for equal access to healthcare (Correct answer)
Free services for patients with disabilities

Correct answer: Reasonable accommodations for equal access to healthcare

The ADA requires reasonable accommodations to ensure patients with disabilities have equal access to healthcare services.

Question 5: How should a prescription refill request received by phone be handled?

Refuse to take the message
Document completely, forward to clinical staff for authorization, follow up with patient (Correct answer)
Authorize the refill directly
Tell patient to call the pharmacy

Correct answer: Document completely, forward to clinical staff for authorization, follow up with patient

Document all details, forward to the appropriate clinical staff for review, and follow up with the patient on the decision.

Question 6: What does 'prior authorization' mean in insurance processing?

Insurance must approve certain services before they are performed (Correct answer)
Patient must pay before service
Patient must sign a consent form
Referring physician must write a letter

Correct answer: Insurance must approve certain services before they are performed

Prior authorization requires insurance company approval before performing certain services, procedures, or prescriptions.

Question 7: What is the difference between an HMO and a PPO?

HMOs have higher premiums
PPOs require a PCP while HMOs do not
No meaningful difference
HMOs require referrals and in-network use; PPOs allow out-of-network at higher cost (Correct answer)

Correct answer: HMOs require referrals and in-network use; PPOs allow out-of-network at higher cost

HMOs require in-network providers and referrals. PPOs allow out-of-network care at higher cost without referrals.

Question 8: A patient calls to confirm their appointment but the time slot cannot be found in the system. What should the medical administrative assistant do first?

Tell the patient they never had an appointment
Search by the patient's name, date of birth, and phone number to locate the record (Correct answer)
Ask the patient to call back later
Create a new appointment immediately

Correct answer: Search by the patient's name, date of birth, and phone number to locate the record

Thorough searching using multiple identifiers can locate records that may have been entered under slightly different information.

Question 9: Which of the following best describes a 'guarantor' on a patient registration form?

The person financially responsible for the patient's account (Correct answer)
The physician responsible for the patient's care
The insurance company covering the patient
The referring provider who sent the patient

Correct answer: The person financially responsible for the patient's account

The guarantor is the individual legally responsible for paying the account balance, which may differ from the patient (e.g., a parent for a minor).

Question 10: In medical billing, what does EOB stand for?

Extension of Benefits
End of Benefits
Explanation of Benefits (Correct answer)
Evidence of Billing

Correct answer: Explanation of Benefits

EOB stands for Explanation of Benefits, a statement from the insurer detailing what was covered and the patient's remaining balance.

Question 11: A patient's insurance plan requires them to pay a fixed amount of $30 for each office visit. This type of payment is called a(n):

Premium
Copayment (Correct answer)
Coinsurance
Deductible

Correct answer: Copayment

A copayment (or copay) is a fixed, flat fee that a patient pays for a covered healthcare service at the time of the visit.

Question 12: A claim is denied because the procedure is 'not medically necessary.' What is the FIRST step?

Re-bill the patient for the full amount
Write off the balance immediately
Review documentation and file an appeal with supporting clinical notes (Correct answer)
Request an itemized bill from the provider

Correct answer: Review documentation and file an appeal with supporting clinical notes

When a claim is denied for medical necessity, the correct first step is to gather supporting documentation and submit a formal appeal to the payer.

Question 13: An 'encounter form' (superbill) in a medical office primarily serves to:

Authorize specialist referrals
Capture diagnosis and procedure codes for billing at the point of care (Correct answer)
Record vital signs and chief complaint
Document the patient's consent for treatment

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 14: Which federal law provided financial incentives for healthcare providers to adopt electronic health records?

HIPAA
EMTALA
HITECH Act (Correct answer)
Affordable Care Act

Correct answer: HITECH Act

The HITECH Act (Health Information Technology for Economic and Clinical Health Act) of 2009 provided financial incentives and penalties to promote EHR adoption.

Question 15: What ethical principle requires healthcare providers to 'do no harm'?

Autonomy
Justice
Nonmaleficence (Correct answer)
Beneficence

Correct answer: Nonmaleficence

Nonmaleficence, from 'primum non nocere,' requires avoiding causing harm to patients.

Question 16: How does a CMAA contribute to the revenue cycle?

Multiple touchpoints: registration, insurance verification, charge capture, claims, and payment collection (Correct answer)
Only answering phones and scheduling
No role in revenue cycle
Only collecting copayments

Correct answer: Multiple touchpoints: registration, insurance verification, charge capture, claims, and payment collection

CMAAs are involved throughout: registration, verification, charge capture, claims processing, payment management, denial management, and collections.

Question 17: For which of the following procedures is obtaining written informed consent MOST likely required?

Administering a seasonal flu vaccine.
A minor surgical procedure performed in the office, such as a mole removal. (Correct answer)
Measuring a patient's blood pressure and heart rate.
Providing a patient with a sample of a non-prescription antacid.

Correct answer: A minor surgical procedure performed in the office, such as a mole removal.

Informed consent is a process where a provider educates a patient about the risks, benefits, and alternatives of a given procedure. While consent is a part of all medical care, written informed consent is typically required for procedures that carry a material risk, such as surgeries (even minor ones), biopsies, and other invasive tests.

Question 18: The 'birthday rule' in insurance coordination of benefits determines:

When a child ages off a parent's plan
The deadline for filing a claim
Which parent's plan is primary when a child is covered by both (Correct answer)
The renewal date of a group health plan

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 19: Which legal doctrine holds that a physician is responsible for the negligent actions of employees working under their supervision?

Contributory negligence
Assumption of risk
Res ipsa loquitur
Respondeat superior (Correct answer)

Correct answer: Respondeat superior

Respondeat superior ('let the master answer') makes employers liable for employees' negligent acts performed within the scope of employment.

Question 20: What is a 'fee schedule' in a medical practice?

The insurer's list of covered procedures
A list of standard charges for services offered by the practice (Correct answer)
A schedule of staff wages
A payment plan offered to patients

Correct answer: A list of standard charges for services offered by the practice

A fee schedule is a comprehensive list of standard charges the practice assigns to each service or procedure it provides.

Question 21: A patient refuses to provide their Social Security Number during registration. What is the appropriate response?

Explain that it is requested but not always mandatory, and proceed using other identifiers such as date of birth and member ID (Correct answer)
Enter a placeholder number in the system
Report the patient to the billing department for non-compliance
Refuse to register the patient until the SSN is provided

Correct answer: Explain that it is requested but not always mandatory, and proceed using other identifiers such as date of birth and member ID

While SSN helps with insurance verification and collections, patients generally cannot be denied care for refusing; alternative identifiers can be used to complete registration.

Question 22: How should intake forms be handled when a patient has a language barrier?

Skip the forms entirely
Ask another patient to translate
Use qualified interpreter services or translated forms (Correct answer)
Have patient sign blank forms to complete later

Correct answer: Use qualified interpreter services or translated forms

Patients with language barriers should receive qualified interpreter services or translated forms to ensure understanding.

Question 23: Under the Health Insurance Portability and Accountability Act (HIPAA), which of the following is the best example of Protected Health Information (PHI)?

Publicly available health statistics from the CDC.
A medical textbook in the office library.
An anonymous patient satisfaction survey.
A patient's name listed on an appointment sign-in sheet. (Correct answer)

Correct answer: A patient's name listed on an appointment sign-in sheet.

Protected Health Information (PHI) is any individually identifiable health information held or transmitted by a covered entity. A patient's name on a sign-in sheet links an individual to the receipt of healthcare services, making it PHI. The other options are not identifiable to a specific individual.

Question 24: Which of the following is an example of a tickler file used in a medical office?

A database of insurance fee schedules
A list of current medication allergies
A log of all incoming faxes
A chronological reminder system for follow-up tasks and due dates (Correct answer)

Correct answer: A chronological reminder system for follow-up tasks and due dates

A tickler file is a date-based organizational tool that prompts staff to complete tasks such as following up on referrals or lab results on a specific future date.

Question 25: Which ICD-10-CM coding convention indicates that an additional code is required to fully describe a condition?

Code first
Use additional code (Correct answer)
Excludes1
Code also

Correct answer: Use additional code

'Use additional code' instructs the coder to assign a supplementary code to provide a more complete picture of the patient's condition.

Question 26: Which form is used by Medicare patients to acknowledge they understand a service may not be covered?

HIPAA Authorization Form
CMS-1500
Advance Beneficiary Notice (ABN) (Correct answer)
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 27: A patient is seen for a follow-up visit for hypertension. The provider also performs a simple, in-office urine test. Which coding manuals should be used to report the diagnosis and services for this encounter?

CPT® only
CPT® and HCPCS Level II only
ICD-10-CM and CPT® only (Correct answer)
ICD-10-CM only

Correct answer: ICD-10-CM and CPT® only

ICD-10-CM is used to code the patient's diagnosis (hypertension). CPT® is used to code the evaluation and management service (the follow-up visit). Since a simple urine test was also performed, this would also be coded using a CPT® code. HCPCS Level II codes are typically for supplies, durable medical equipment, and services not included in CPT®, which are not indicated here.

Question 28: What does the term 'credit balance' mean on a patient's account?

The patient owes money for services rendered
The account has been sent to collections
The practice owes money back to the patient due to an overpayment (Correct answer)
The insurance has not yet paid the claim

Correct answer: The practice owes money back to the patient due to an overpayment

A credit balance indicates the patient (or insurer) has paid more than was owed, and the practice must issue a refund.

Question 29: If a HIPAA breach is discovered, the covered entity must notify affected individuals within:

60 days of discovery (Correct answer)
30 days of discovery
90 days of discovery
6 months of discovery

Correct answer: 60 days of discovery

HIPAA's Breach Notification Rule requires covered entities to notify affected individuals within 60 days of discovering a breach of unsecured PHI.

Question 30: Which of the following is a core administrative responsibility of a Certified Medical Administrative Assistant?

Scheduling patient appointments and managing medical records (Correct answer)
Diagnosing patient conditions based on symptoms
Performing routine blood draws and lab specimen collection
Prescribing medications for minor ailments

Correct answer: Scheduling patient appointments and managing medical records

CMAAs are trained in front-office and administrative functions such as scheduling, medical records management, billing, and patient communication — not clinical diagnosis or prescribing.

Question 31: An employee receives a corrective action memo from their supervisor. The MOST professional response is to:

Immediately file a grievance with HR
Review the feedback, acknowledge receipt, and schedule a meeting to discuss improvement (Correct answer)
Discuss the memo with coworkers to get their opinions
Ignore the memo and continue working as usual

Correct answer: Review the feedback, acknowledge receipt, and schedule a meeting to discuss improvement

Acknowledging feedback professionally and engaging in constructive dialogue demonstrates accountability and a commitment to improvement.

Question 32: What is the ideal time to book a new patient's appointment if they phone at 8:00 AM on June 6 to discuss their escalating foot swelling and slight breathlessness? The appointment matrix displays the following.

8:50 June 7.
8:20 June 7.
9:00 June 6. (Correct answer)
8:10 June 6.

Correct answer: 9:00 June 6.

The doctor will need more time to take a history, perform a physical examination, and examine the patient in order to determine the likely diagnosis and the best course of treatment if a new patient complaining of increasing foot edema (swelling) and shortness of breath is being scheduled. On June 6, at 9:00 AM, the first longer time period will be made available. The visit shouldn't be postponed till June 7 because the patient complains of shortness of breath.

Question 33: The CMAA should take action if the doctor wrote on the patient's encounter form that the patient should return in a week for a follow-up exam but that there are no appointment slots available for a month.

schedule the patient by phone after a cancellation.
make the appointment in one month.
double-book the patient.
ask the physician if the patient can wait one month. (Correct answer)

Correct answer: ask the physician if the patient can wait one month.

The CMA should ask the doctor if the patient can wait one month if the doctor has written on the patient's encounter form that they should return in a week for a follow-up exam but there are no appointment slots available for that month. If not, the patient should be double-booked with the caveat that there may be a brief wait at the appointment. The patient can be rescheduled in the event of a cancellation.

Question 34: The medical administrative assistant discovers a box of gauze pads in the supply closet that expired six months ago. The MOST appropriate action is to:

Donate them to a community clinic without documentation
Label them 'use first' and place them at the front of the shelf
Continue using them if the packaging appears undamaged
Remove and dispose of them per facility policy and replace with current stock (Correct answer)

Correct answer: Remove and dispose of them per facility policy and replace with current stock

Expired supplies must be removed from use and disposed of according to facility and regulatory policies. Using expired medical supplies risks patient safety and creates legal liability. Proper disposal documentation may also be required.

Question 35: Which ethical principle requires healthcare providers to distribute resources and treatment fairly among all patients?

Justice (Correct answer)
Veracity
Autonomy
Beneficence

Correct answer: Justice

Justice is the bioethical principle requiring fair, equitable, and appropriate distribution of healthcare resources and treatment.

Question 36: What is the role of a clearinghouse in medical billing?

Physical bill-payment location
Intermediary that checks claims for errors, reformats, and forwards to insurance companies (Correct answer)
Government insurance regulator
Office billing department

Correct answer: Intermediary that checks claims for errors, reformats, and forwards to insurance companies

Clearinghouses receive claims from providers, scrub for errors, convert to standard format, and route to the correct payer.

Question 37: What is the primary purpose of a 'superbill' in a medical office?

To document and charge services provided during a visit (Correct answer)
To record a patient's medical history
To verify a patient's insurance coverage
To schedule follow-up appointments

Correct answer: To document and charge services provided during a visit

A superbill is an itemized form that documents services provided during a visit, including CPT and diagnosis codes used for billing.

Question 38: Which disclosures are exempt from HIPAA's accounting of disclosures requirement?

Disclosures for judicial proceedings
Disclosures for treatment, payment, and healthcare operations (Correct answer)
Disclosures to law enforcement
Disclosures for public health

Correct answer: Disclosures for treatment, payment, and healthcare operations

TPO disclosures are exempt because they occur so frequently that tracking each one would be impractical.

Question 39: The section of the patient intake paperwork that gathers details about past surgeries, existing medical conditions, and known allergies is called the:

Demographic Information Sheet
Financial Responsibility Agreement
Insurance Verification Form
Medical History Form (Correct answer)

Correct answer: Medical History Form

The medical history form is specifically designed to collect crucial clinical information about the patient's past and present health. This includes past medical history, surgical history, family history, social history, and allergies, all of which are vital for the provider to ensure safe and effective care.

Question 40: Which of the following is an example of an accounts payable transaction in a medical practice?

A patient pays an outstanding balance
The practice pays an invoice for medical supplies (Correct answer)
Insurance sends a reimbursement check
A patient pays their co-pay

Correct answer: The practice pays an invoice for medical supplies

Accounts payable represents money the practice owes to vendors; paying a supply invoice is a typical accounts payable transaction.

Question 41: Which of the following is an example of a SOAP note element completed by clinical staff that an administrative assistant might file?

F - Financial: the patient's copay collected
S - Subjective: the patient's reported symptoms (Correct answer)
B - Billing: the codes assigned for the visit
A - Administrative: appointment scheduling details

Correct answer: S - Subjective: the patient's reported symptoms

The 'S' in SOAP stands for Subjective and captures the patient's own description of their symptoms and complaints.

Question 42: A patient calls the office asking for their test results to be left on their home answering machine. The medical administrative assistant should:

Leave a brief message with full results since the patient requested it
Transfer the call to the physician only
Decline, as leaving any message violates HIPAA
Honor the request by leaving only the minimum necessary information and a callback number (Correct answer)

Correct answer: Honor the request by leaving only the minimum necessary information and a callback number

HIPAA allows covered entities to communicate with patients by their preferred method, including voicemail, but only the minimum necessary information should be left.

Question 43: A colleague makes a suggestion you disagree with in a team meeting. What is the most professional response?

Listen respectfully, acknowledge valid points, and share your perspective with reasoning (Correct answer)
Roll your eyes and ignore it
Stay silent and complain to others afterward
Tell them they're wrong in front of everyone

Correct answer: Listen respectfully, acknowledge valid points, and share your perspective with reasoning

Professional disagreement: listen fully, acknowledge merits, frame disagreement around the issue with specific reasoning.

Question 44: When a patient pays with a personal check and it is returned due to insufficient funds, what should the medical office do first?

Write off the amount as uncollectible
Redeposit the check without contacting the patient
Notify the patient and request payment via cash or money order (Correct answer)
Immediately refer the account to a collection agency

Correct answer: Notify the patient and request payment via cash or money order

The first step is to notify the patient of the returned check and request immediate payment by cash or money order.

Question 45: What is the significance of the Notice of Privacy Practices under HIPAA?

Gives permission to share all info freely
Informs patients of their PHI rights, how the practice uses their information, and how to file complaints (Correct answer)
Only required for hospitals
Optional courtesy document

Correct answer: Informs patients of their PHI rights, how the practice uses their information, and how to file complaints

The NPP is a legally required document informing patients about their HIPAA rights, PHI use, and complaint procedures.

Question 46: What is the correct new patient processing sequence?

Copy insurance card and send to exam room
Collect payment, see doctor, then paperwork
Sign HIPAA form and collect copay only
Greet, distribute forms, collect completed forms, verify insurance, copy ID and cards, collect copay (Correct answer)

Correct answer: Greet, distribute forms, collect completed forms, verify insurance, copy ID and cards, collect copay

Systematic processing: greeting, registration forms, form review, insurance verification, ID/card copies, and copay collection.

Question 47: Which scheduling scenario best demonstrates the use of a 'buffer' time slot?

Scheduling all appointments at the start of the day
Scheduling two patients at the exact same time
Leaving a 10-minute open slot between complex appointments to handle overruns (Correct answer)
Booking appointments back-to-back with no gaps

Correct answer: Leaving a 10-minute open slot between complex appointments to handle overruns

Buffer slots are intentional gaps placed in the schedule to absorb delays from longer-than-expected appointments and prevent cascading delays.

Question 48: What does 'accounts receivable' represent in a medical practice?

Money the practice owes to vendors
Employee payroll expenses
Money owed to the practice for services rendered (Correct answer)
Equipment purchase costs

Correct answer: Money owed to the practice for services rendered

Accounts receivable (A/R) represents money owed to the practice by patients and insurance companies for services already provided.

Question 49: The prefix 'poly-' in medical terminology means:

Many or excessive (Correct answer)
Between or among
Few or deficient
Around or surrounding

Correct answer: Many or excessive

Poly- means many or excessive, as in polydipsia (excessive thirst) or polyuria (excessive urination).

Question 50: Which of the following is an example of a Clinical Decision Support (CDS) tool within an EHR?

A billing module that submits electronic claims to payers
An online scheduling calendar for patient appointments
A patient-facing portal for secure messaging with providers
An automated alert warning a provider of a potential drug-drug interaction (Correct answer)

Correct answer: An automated alert warning a provider of a potential drug-drug interaction

Clinical Decision Support tools in EHRs provide real-time, evidence-based alerts and recommendations—such as drug interaction warnings—to help providers make safer and more informed clinical decisions.

Question 51: What information is required on a patient receipt in a medical office?

Only the diagnosis and treatment codes
Only the amount paid
Date, services provided, amount charged, payment received, and balance (Correct answer)
Patient insurance ID and provider NPI only

Correct answer: Date, services provided, amount charged, payment received, and balance

A complete patient receipt should include the date, services rendered, amount charged, payment received, and any remaining balance.

Question 52: What is the anatomical term for the front surface of the body?

Lateral
Superior
Posterior
Anterior (Correct answer)

Correct answer: Anterior

Anterior refers to the front surface of the body, opposite to posterior (back).

Question 53: A medical office uses the accrual accounting method. When is revenue recognized?

When the claim is submitted to the payer
When the explanation of benefits is received
When cash is received from the patient or insurer
When the service is rendered, regardless of payment receipt (Correct answer)

Correct answer: When the service is rendered, regardless of payment receipt

Under accrual accounting, revenue is recorded when the service is provided, not when payment is actually received.

Question 54: Which of the following is an example of nonverbal communication that can negatively impact patient interaction?

Nodding to acknowledge understanding
Maintaining appropriate eye contact
Leaning slightly forward to show interest
Crossing your arms and avoiding eye contact (Correct answer)

Correct answer: Crossing your arms and avoiding eye contact

Crossed arms and avoiding eye contact signal defensiveness or disinterest, undermining patient trust.

Question 55: What does 'EOB' stand for in medical billing?

Explanation of Benefits (Correct answer)
Evaluation of Benefits
Estimate of Balance
Evidence of Billing

Correct answer: Explanation of Benefits

EOB stands for Explanation of Benefits, a document from insurance companies detailing how a claim was processed.

Question 56: Which demonstrates proper professional email etiquette?

Marking all emails as urgent
Clear subject line, professional greeting, concise message, and proofreading before sending (Correct answer)
Abbreviations and slang to save time
All capital letters for emphasis

Correct answer: Clear subject line, professional greeting, concise message, and proofreading before sending

Professional emails need a descriptive subject line, proper greeting, concise body, professional closing, and proofreading.

Question 57: Why must CMAAs understand medical abbreviations?

Only relevant to physicians
Should never be used
Only billing abbreviations matter
Enables accurate document interpretation, proper routing, and effective clinical support (Correct answer)

Correct answer: Enables accurate document interpretation, proper routing, and effective clinical support

CMAAs encounter abbreviations in records, prescriptions, orders, and correspondence, making understanding essential for accurate handling.

Question 58: What is the proper way to dispose of documents containing PHI?

Regular trash at end of day
Tear in half and recycle
Store indefinitely in locked cabinet
Cross-cut shredder or certified document destruction service (Correct answer)

Correct answer: Cross-cut shredder or certified document destruction service

PHI documents must be rendered unreadable through cross-cut shredding or certified HIPAA-compliant destruction services.

Question 59: What is the purpose of a 'remittance advice' (RA) sent by an insurance payer?

To explain how each claim was adjudicated, including payment amounts and denial reasons (Correct answer)
To authorize future procedures for a specific patient
To notify the patient of their out-of-pocket responsibility
To list all providers credentialed with the payer

Correct answer: To explain how each claim was adjudicated, including payment amounts and denial reasons

A remittance advice is sent to the provider and details how each submitted claim was processed, including payments made and reasons for any adjustments or denials.

Question 60: Which body system includes the trachea, bronchi, and lungs?

Endocrine system
Cardiovascular system
Respiratory system (Correct answer)
Digestive system

Correct answer: Respiratory system

The respiratory system includes the trachea, bronchi, and lungs, all involved in breathing.

Question 61: Under the HIPAA Privacy Rule, which of the following uses of PHI does NOT require patient authorization?

Using PHI for marketing a new prescription drug
Sharing PHI with a public health authority to report a communicable disease (Correct answer)
Disclosing PHI to the patient's employer for pre-employment screening
Selling PHI to a pharmaceutical research company

Correct answer: Sharing PHI with a public health authority to report a communicable disease

Public health activities, such as reporting communicable diseases to authorized public health authorities, are permitted disclosures under HIPAA without patient authorization.

Question 62: A patient has a $2,000 deductible and has met $1,500. The visit costs $200. How much applies to the deductible?

$1,500
$0
$200 (Correct answer)
$500

Correct answer: $200

With $500 remaining on the deductible, the full $200 visit applies since it's less than the remaining amount.

Question 63: A practice's collection ratio is calculated as:

Total charges divided by total payments
Total write-offs divided by total payments
Total payments collected divided by total net charges (Correct answer)
Total adjustments divided by total charges

Correct answer: Total payments collected divided by total net charges

The collection ratio measures efficiency by dividing total collections by total net (after adjustments) charges, expressed as a percentage.

Question 64: What is coordination of benefits (COB)?

Scheduling multiple procedures on the same day
Determining payment order when a patient has multiple insurance plans (Correct answer)
Verifying eligibility before services
Coordinating referrals between specialists

Correct answer: Determining payment order when a patient has multiple insurance plans

COB determines which plan pays first (primary) and second (secondary) when a patient has multiple insurance plans.

Question 65: A medical office's 'aging report' organizes outstanding balances by which criterion?

Patient name alphabetically
How long the balance has been outstanding (Correct answer)
Amount owed from largest to smallest
Insurance company name

Correct answer: How long the balance has been outstanding

An aging report categorizes outstanding accounts receivable by how long they have been unpaid, typically in 30-day increments.

Question 66: What is the purpose of an NPI (National Provider Identifier)?

To identify the patient's primary diagnosis
To assign reimbursement rates to providers
To uniquely identify healthcare providers in standard transactions (Correct answer)
To classify the type of insurance plan

Correct answer: To uniquely identify healthcare providers in standard transactions

The NPI is a unique 10-digit number assigned to healthcare providers for use in HIPAA standard transactions.

Question 67: How should a hostile patient situation be handled in the waiting room?

Argue to calm them down
Ignore and hope they stop
Ask other patients to leave
Follow safety protocol, remain calm, contact security if necessary (Correct answer)

Correct answer: Follow safety protocol, remain calm, contact security if necessary

Follow the safety protocol: remain calm, use de-escalation, ensure safety, and contact security or law enforcement if needed.

Question 68: What does "H & P" on a medical record mean?

history and physical. (Correct answer)
help and provisions.
healthcare provider.
health priorities.

Correct answer: history and physical.

History and physical are referred to as ""H & P"" in the medical file. Other frequently used acronyms include: - Hx is the history. - Diagnosis is a Dx. - I & O stand for intake and outflow. and etc.

Question 69: Which suffix indicates a condition of pain?

-algia (Correct answer)
-itis
-emia
-osis

Correct answer: -algia

The suffix -algia means pain, as seen in myalgia (muscle pain) or neuralgia (nerve pain).

Question 70: Which of the following constitutes an example of administrative malpractice by a CMAA?

Failing to record a patient's stated allergy to penicillin, leading to an incorrect prescription. (Correct answer)
Refusing to schedule an appointment for a patient who has an outstanding balance.
Recommending an over-the-counter medication to a patient.
Discussing a patient's difficult diagnosis with a coworker in the breakroom.

Correct answer: Failing to record a patient's stated allergy to penicillin, leading to an incorrect prescription.

Medical malpractice is not limited to clinical staff; administrative errors can also lead to patient harm and legal liability. Failing to accurately record critical information like a known allergy is a breach of the standard of care for an administrative role. If this error leads directly to patient harm, it can be considered administrative malpractice.

Question 71: The combining form 'oste/o' refers to which body structure?

Tendon
Muscle
Bone (Correct answer)
Cartilage

Correct answer: Bone

Oste/o is the combining form for bone, used in terms like osteoporosis and osteomyelitis.

Question 72: Which coding system is primarily used by CMAAs when entering diagnoses for insurance claim submission?

NPI (National Provider Identifier) codes
CPT (Current Procedural Terminology)
HCPCS Level I codes only
ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) (Correct answer)

Correct answer: ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification)

ICD-10-CM codes are the standardized system used to classify and report patient diagnoses on insurance claims. CPT codes describe procedures, while NPI numbers identify providers.

Question 73: A patient receives services from both an in-network and an out-of-network provider during a single hospital stay. What billing term describes this situation?

Balance billing exposure (Correct answer)
Mixed-network encounter
Dual coverage
Split billing

Correct answer: Balance billing exposure

Balance billing exposure occurs when an out-of-network provider bills the patient for the difference between their charge and the insurer's allowed amount.

Question 74: Which of the following is considered best practice for EHR password management?

Writing passwords on a note kept near the workstation for quick reference
Sharing login credentials with a trusted colleague when unavailable
Using the same password across all healthcare systems for convenience
Creating strong, unique passwords and updating them on a regular schedule (Correct answer)

Correct answer: Creating strong, unique passwords and updating them on a regular schedule

Best practice requires strong, unique passwords that are changed regularly; sharing credentials or writing them down violates HIPAA security standards and increases breach risk.

Question 75: Which CPT code range is designated for Evaluation and Management (E/M) services?

70000-79999
10000-69999
99201-99499 (Correct answer)
80000-89999

Correct answer: 99201-99499

CPT codes 99201-99499 cover Evaluation and Management services, the most commonly used codes for office visits.

Question 76: Which organization offers the CMAA certification?

AHIMA
JCAHO
NHA (Correct answer)
AMA

Correct answer: NHA

The National Healthcareer Association administers the CMAA certification exam.

Question 77: What is a Health Information Exchange (HIE)?

A patient's statutory right to request and receive copies of their medical records
A type of clearinghouse that reformats claims before submission to payers
A marketplace where hospitals purchase and license EHR software
A secure electronic network that enables healthcare providers to share patient information across organizations (Correct answer)

Correct answer: A secure electronic network that enables healthcare providers to share patient information across organizations

A Health Information Exchange (HIE) is a network infrastructure that allows authorized providers and patients to share clinical information electronically across different health organizations.

Question 78: What is the filing deadline (timely filing limit) concept in medical billing?

The date by which a patient must pay their balance
The maximum time an insurance carrier allows for submitting a claim after the date of service (Correct answer)
The deadline for a provider to respond to an audit request
The grace period before a patient's coverage lapses

Correct answer: The maximum time an insurance carrier allows for submitting a claim after the date of service

Timely filing limits set by insurers define the window after service in which claims must be submitted or they will be denied.

Question 79: A pharmaceutical rep asks for a list of patients on a specific medication. What is the correct response?

Provide it with a signed confidentiality agreement
Decline as it violates HIPAA (Correct answer)
Share with physician verbal approval
Provide it without addresses

Correct answer: Decline as it violates HIPAA

Sharing medication lists with pharmaceutical reps violates HIPAA as unauthorized disclosure for non-treatment, payment, or operations purposes.

Question 80: When a patient calls to cancel a same-day appointment, what is the BEST immediate action?

Delete the appointment without documentation
Charge the patient a no-show fee immediately
Leave the slot empty for walk-ins only
Document the cancellation and offer the slot to a waitlisted patient (Correct answer)

Correct answer: Document the cancellation and offer the slot to a waitlisted patient

Documenting cancellations and filling vacancies from a waitlist maximizes provider productivity and maintains accurate records.

Question 81: Under which federal law can a patient access their complete medical record?

FOIA
HIPAA Privacy Rule (Correct answer)
FMLA
ADA

Correct answer: HIPAA Privacy Rule

The HIPAA Privacy Rule grants patients the right to access, inspect, and copy their PHI in the designated record set.

Question 82: What is a 'contraindication' in medical practice?

A prescription drug interaction
A factor making a treatment inadvisable (Correct answer)
A recommended treatment
A reason to proceed with therapy

Correct answer: A factor making a treatment inadvisable

A contraindication is a condition or factor that makes a particular treatment or procedure inadvisable.

Question 83: What is the purpose of a financial responsibility agreement during intake?

Authorize selling debt to collections immediately
Establish the patient's obligation to pay for uncovered services and outline payment expectations (Correct answer)
Guarantee unlimited free care
Waive the patient's right to dispute charges

Correct answer: Establish the patient's obligation to pay for uncovered services and outline payment expectations

This agreement establishes payment obligations for uncovered services and outlines billing and collection policies.

Question 84: A Coordination of Benefits (COB) clause prevents:

Employees from waiving employer-sponsored coverage
Providers from balance-billing Medicare patients
Double payment exceeding 100% of actual charges (Correct answer)
Patients from changing insurance carriers mid-year

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.

Question 85: A patient arrives for an appointment but their insurance card shows a different group number than what is on file. What is the correct action?

Schedule the appointment and update the record later
Verify the current insurance information with the patient and update the record before the visit (Correct answer)
Ask the patient to reschedule until the discrepancy is resolved
Proceed with the old group number to avoid delays

Correct answer: Verify the current insurance information with the patient and update the record before the visit

Insurance information should be verified and updated at every visit to ensure accurate billing and avoid claim denials.

Question 86: Which of the following best describes petty cash in a medical office?

A small amount of cash kept on hand for minor office expenses (Correct answer)
Funds reserved for equipment purchases
Patient refund money
Insurance premium payments

Correct answer: A small amount of cash kept on hand for minor office expenses

Petty cash is a small, accessible fund kept in the office to cover minor day-to-day expenses that are impractical to pay by check or card.

Question 87: Which of the following describes the patient's financial responsibility that is a percentage of the allowed amount for a service, which they must pay after their deductible has been met?

Allowed Amount
Premium
Coinsurance (Correct answer)
Copayment

Correct answer: Coinsurance

Coinsurance is the percentage of costs of a covered health care service you pay after you've paid your deductible. For example, with an 80/20 coinsurance plan, the insurance company pays 80% and the patient is responsible for 20%.

Question 88: Which scheduling method sets aside specific time slots each day for walk-in or urgent patients?

Wave scheduling
Open booking
Modified wave scheduling (Correct answer)
Cluster scheduling

Correct answer: Modified wave scheduling

Modified wave scheduling builds in buffer slots at predictable intervals to accommodate urgent or walk-in patients without disrupting the schedule.

Question 89: How does workers' compensation billing differ from standard insurance?

Patient pays and is reimbursed
No difference
Billed to employer's workers' comp carrier; patient has no copay or deductible (Correct answer)
Cannot be billed electronically

Correct answer: Billed to employer's workers' comp carrier; patient has no copay or deductible

Workers' comp claims go to the employer's carrier, not patient insurance. The employee typically has zero out-of-pocket costs.

Question 90: What is the difference between a deductible and a copayment?

Same thing, different names
Copayment is always higher
Deductible only for hospitals; copay for offices
Deductible is annual amount before insurance covers costs; copayment is fixed per-visit fee (Correct answer)

Correct answer: Deductible is annual amount before insurance covers costs; copayment is fixed per-visit fee

A deductible is the annual threshold before insurance pays; a copayment is a fixed fee at each visit regardless of deductible.

Question 91: How should written communication be adapted for patients with low health literacy?

Write at college reading level
Use plain language, short sentences, visual aids, and teach-back method (Correct answer)
Use complex medical terms to educate them
Avoid written communication entirely

Correct answer: Use plain language, short sentences, visual aids, and teach-back method

Use plain language at 5th-6th grade level with visual aids, short sentences, and teach-back method to verify understanding.

Question 92: Which of the following vaccination records should be maintained for staff in a medical office?

Hepatitis B and annual influenza vaccinations at minimum (Correct answer)
Only vaccines required for travel
Vaccinations are not required for administrative staff
Only childhood immunizations

Correct answer: Hepatitis B and annual influenza vaccinations at minimum

OSHA and healthcare regulations typically require medical office staff to have documented Hepatitis B and influenza vaccination status.

Question 93: What would the CMAA say if the patient questioned the meaning of the doctor's instructions, "Eye drops--gtt ii OD TID"?

“Administer eye drops with two drops in the right eye two times a day.”
“Administer eye drops with two drops in the right eye three times a day.” (Correct answer)
“Administer eye drops with two drops in the left eye two times a day.”
“Administer eye drops with two drops in the left eye three times a day.”

Correct answer: “Administer eye drops with two drops in the right eye three times a day.”

Roman numerals are frequently used in medical prescriptions, but sometimes in lower case—ii instead of II—because the dots help to reinforce the number. For example, if the doctor has given the patient instructions that state "Eye drops--gtt ii OD TID," and the patient asks what it means, the CMAA would respond: "Administer eye drops with two drops in the right eye three times a day."

Question 94: A new patient provides their insurance card at check-in. Which of the following is the MOST critical first step for the CMAA to take to prevent claim denials?

Ask the patient to sign a financial responsibility form.
Collect the copayment listed on the card.
Scan a copy of the card for the patient's record.
Verify insurance eligibility and benefits. (Correct answer)

Correct answer: Verify insurance eligibility and benefits.

Verifying insurance eligibility and benefits is the most critical initial step. This process confirms that the patient's coverage is active on the date of service and clarifies what services are covered, preventing future claim denials and ensuring the patient understands their financial responsibility.

Question 95: How long must a covered entity retain HIPAA-related documentation?

3 years
10 years
Indefinitely
6 years from creation or last effective date (Correct answer)

Correct answer: 6 years from creation or last effective date

HIPAA requires retaining policies, procedures, and authorization forms for 6 years from creation or last effective date, whichever is later.

Question 96: In medical billing, 'clean claim' refers to a claim that:

Was submitted within 24 hours of service
Has passed an audit review
Has been paid in full
Contains no errors and can be processed without additional information (Correct answer)

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 97: Which standard electronic transaction is used for insurance eligibility verification?

ANSI 270/271 (Correct answer)
ANSI 276/277
ANSI 835
ANSI 837P

Correct answer: ANSI 270/271

The 270/271 transaction set handles eligibility inquiries (270) and responses (271).

Question 98: An EHR audit trail is important because it:

Converts handwritten notes to digital text
Transmits records to insurance companies
Records who accessed or modified a patient record and when (Correct answer)
Automatically corrects errors in documentation

Correct answer: Records who accessed or modified a patient record and when

An audit trail logs all access and changes to electronic health records, providing accountability and supporting compliance investigations.

Question 99: What is the purpose of a Notice of Privacy Practices (NPP)?

To document that a patient waived their HIPAA rights
To authorize disclosure of PHI to business associates
To inform patients of how their PHI may be used and their rights regarding that information (Correct answer)
To obtain patient consent for all uses of their health information

Correct answer: To inform patients of how their PHI may be used and their rights regarding that information

The NPP informs patients about how the covered entity may use and disclose their PHI and describes the patient's rights under HIPAA.

Question 100: A CMAA discovers an incorrect entry in a patient's paper medical record. What is the proper procedure to correct this error?

Erase the error cleanly and carefully write the correct information in the same spot.
Black out the incorrect entry with a permanent marker and write the correction nearby.
Use correction fluid to completely cover the error and write the correct information over it.
Draw a single line through the incorrect entry, write the correction, and add the date and their initials. (Correct answer)

Correct answer: Draw a single line through the incorrect entry, write the correction, and add the date and their initials.

The legally accepted method for correcting an error in a paper medical record is to draw a single line through the incorrect information, ensuring it remains legible. The person making the correction should then write the correct information, add the current date, and sign or initial the entry. This method maintains the integrity of the medical record by providing a clear audit trail of all changes.

Question 101: A patient has a $500 deductible, has met $300 so far, and receives a $400 service. How much of this visit applies to the deductible?

$300
$100
$200 (Correct answer)
$400

Correct answer: $200

The patient still needs $200 more to meet the $500 deductible ($500 − $300 = $200), so $200 of the $400 service applies to the deductible.

Question 102: Which of the following information is typically required when submitting a prior authorization request to an insurance company?

Provider's NPI, procedure codes (CPT), diagnosis codes (ICD), and clinical justification (Correct answer)
The facility's Joint Commission accreditation certificate number
Patient's previous year's tax return and income verification
Patient's credit score and billing payment history

Correct answer: Provider's NPI, procedure codes (CPT), diagnosis codes (ICD), and clinical justification

Payers evaluate prior authorization requests using clinical and administrative data: the ordering provider's NPI (National Provider Identifier), CPT codes for the requested service, ICD-10 diagnosis codes, and documentation justifying medical necessity. Financial or accreditation information is not part of this process.

Question 103: What is the primary purpose of the HIPAA Privacy Rule?

To streamline the process for electronic billing and claims submission.
To give patients rights over their health information and to set limits on its use and disclosure without their authorization. (Correct answer)
To set national standards for the security of electronic protected health information (ePHI).
To establish a patient's right to sue their healthcare provider for malpractice.

Correct answer: To give patients rights over their health information and to set limits on its use and disclosure without their authorization.

The main goal of the HIPAA Privacy Rule is to ensure that individuals' health information is properly protected while allowing the flow of information needed for high-quality care. It establishes national standards and gives patients specific rights to control how their health information is used and disclosed.

Question 104: Which legal doctrine holds physicians responsible for their employees' actions?

Respondeat superior (Correct answer)
Informed consent
Statute of limitations
Good Samaritan law

Correct answer: Respondeat superior

Respondeat superior holds employers vicariously liable for employees' negligent actions within employment scope.

Question 105: Which payment method describes a set monthly fee paid per patient regardless of services used?

Bundled payment
Capitation (Correct answer)
Fee-for-service
Pay-for-performance

Correct answer: Capitation

Capitation is a payment model in which providers receive a fixed monthly fee per enrolled patient, regardless of how many services are rendered.

Question 106: What is the purpose of an office inventory management system?

Track appointments and cancellations
Manage marketing campaigns
Record employee attendance
Monitor and maintain adequate supplies of medical and office materials (Correct answer)

Correct answer: Monitor and maintain adequate supplies of medical and office materials

Inventory management tracks supplies, ensures adequate stock, prevents shortages, and controls costs.

Question 107: What is double-booking, and when might it be appropriate?

Booking two and canceling whichever arrives second
Two patients in one slot; appropriate when one is quick and the other needs extended time (Correct answer)
Same patient with two providers on one day
Never appropriate

Correct answer: Two patients in one slot; appropriate when one is quick and the other needs extended time

Double-booking pairs a quick visit with a longer one where the provider can alternate between rooms.

Question 108: What action should a medical administrative assistant take when a caller becomes verbally abusive?

Transfer the call to any available staff member to avoid the situation
Hang up immediately without warning
Calmly warn the caller that the behavior must stop or the call will end, then follow through if necessary (Correct answer)
Apologize repeatedly and continue attempting to help the caller

Correct answer: Calmly warn the caller that the behavior must stop or the call will end, then follow through if necessary

Professional de-escalation involves calmly setting a behavioral boundary and ending the call if the behavior continues, following office policy.

Question 109: You are verifying insurance for a patient who has both a primary and secondary insurer. The secondary insurer uses the 'non-duplication' provision. What does this mean?

The patient cannot use two insurers for the same service
The secondary plan will not pay if the primary plan paid at least as much as the secondary plan would have paid on its own (Correct answer)
The secondary insurer pays first for preventive services
The secondary plan duplicates the primary plan's payment exactly

Correct answer: The secondary plan will not pay if the primary plan paid at least as much as the secondary plan would have paid on its own

A non-duplication provision means the secondary plan pays nothing if the primary plan's payment equals or exceeds what the secondary plan would have paid as the primary payer.

Question 110: What is the purpose of verifying identity with a photo ID during check-in?

Ensure patient is old enough to be seen alone
Add photo to social media
Prevent identity theft, insurance fraud, and medical identity errors (Correct answer)
Comply with immigration laws

Correct answer: Prevent identity theft, insurance fraud, and medical identity errors

Identity verification prevents medical identity theft, insurance fraud, and dangerous treatment under the wrong medical record.

Question 111: When a patient presents with a workers' compensation injury, which information is ESSENTIAL to collect at registration?

Patient's preferred pharmacy
Patient's personal health insurance card only
Employer name, date of injury, claim number, and workers' comp carrier information (Correct answer)
Next of kin contact details

Correct answer: Employer name, date of injury, claim number, and workers' comp carrier information

Workers' compensation claims require specific employer and claim details because billing goes to the WC carrier, not the patient's personal health insurance.

Question 112: In ICD-10-CM coding, the convention 'Code first underlying disease' instructs the coder to:

Query the physician before assigning any diagnosis code
Sequence the etiology (underlying disease) code before the manifestation code (Correct answer)
Use the manifestation code as the principal diagnosis in all settings
Assign only the manifestation code and omit the underlying condition

Correct answer: Sequence the etiology (underlying disease) code before the manifestation code

When a condition has both an underlying etiology and a manifestation, ICD-10-CM instructs coders to list the etiology code first, followed by the manifestation code, to accurately reflect the cause-and-effect relationship.

CMAA (Certified Medical Administrative Assistant) Exam

The CMAA (Certified Medical Administrative Assistant) Exam exam validates essential knowledge and skills required for certification or licensure in this field.

110

Questions

120 min

Time Limit

68%

To Pass

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