Medical Office Administration and Billing Flashcards
6 cards from real NCMA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Medical Office Administration and Billing flashcards as text
What is the purpose of an Explanation of Benefits (EOB) that a patient receives from their insurance company?
Answer: A statement from the insurer explaining what was billed, what was allowed, what the plan paid, and the patient's remaining responsibility
An Explanation of Benefits (EOB) is a statement from the insurer detailing how a claim was processed — showing the billed amount, the allowed amount, the insurer's payment, adjustments, and the amount remaining as patient responsibility. It is NOT a bill.
When a patient without insurance asks about payment options, what is an appropriate response from the medical assistant?
Answer: Explain available options such as self-pay discounts, payment plans, healthcare financing, and community resources or sliding scale programs
Medical assistants serve as patient advocates. For uninsured patients, appropriate options include explaining self-pay discount policies, offering payment plans, providing information about healthcare financing programs, community health centers with sliding scale fees, and state Medicaid eligibility.
What is the role of a clearinghouse in the medical billing process?
Answer: An intermediary that receives claims from providers, checks for errors, reformats them to payer specifications, and transmits them to the appropriate insurer
A clearinghouse is a third-party intermediary that acts as a hub between healthcare providers and payers, receiving electronic claims, performing error checking (claim scrubbing), reformatting to payer requirements, and routing to the correct payer.
Which type of fraud involves billing for services at a higher level than what was actually documented or performed?
Answer: Upcoding
Upcoding is a form of healthcare fraud in which a provider bills for a higher-level service (higher CPT code) than was actually performed or documented. For example, billing for a Level 4 E&M visit when only a Level 2 was performed.
What is the purpose of maintaining an appointment recall system in a medical office?
Answer: To proactively contact patients due for follow-up, preventive care, or chronic disease management to improve continuity of care and patient outcomes
A recall system proactively identifies and contacts patients who are due for follow-up visits, annual physicals, chronic disease monitoring, immunizations, or preventive screenings — improving continuity of care, patient outcomes, and practice revenue.
A patient's account has been sent to collections after multiple failed payment attempts. The patient calls and says they cannot afford to pay. What should the medical assistant do?
Answer: Listen empathetically, document the call, and connect the patient with the billing supervisor or financial counselor to explore hardship programs, payment plans, or charity care options
Even accounts in collections may have resolution options. The appropriate response is to listen with empathy, document the communication, and refer to the billing supervisor or financial counselor who can assess eligibility for hardship programs, payment plans, or charitable write-off.