CMAA Comprehensive Review Flashcards

A patient calls requesting a refill on a controlled substance. The medical administrative assistant should:

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.

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

Answer: Advance Beneficiary Notice (ABN)

An ABN is given to Medicare patients before a service that may be denied, so they understand financial responsibility.

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

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.

Which of the following best describes the role of a medical administrative assistant regarding medication administration?

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.

What does the abbreviation 'EOB' stand for in healthcare billing?

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.

A patient presents with a Medicare card and a secondary insurance card. Which insurance should be billed first?

Answer: Medicare

Medicare is typically the primary payer unless the patient has employer-sponsored insurance through active employment.

The process of verifying a patient's insurance eligibility before a visit is important primarily to:

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.