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

Question 1: What is the purpose of an office inventory management system?

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

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 2: Which form is used by patients to authorize the release of their medical records to a third party?

ABN (Advance Beneficiary Notice)
HIPAA Privacy Notice
Authorization for Release of Medical Information (Correct answer)
CMS-1500

Correct answer: Authorization for Release of Medical Information

An Authorization for Release of Medical Information form is the proper document patients sign to allow their records to be shared with a third party.

Question 3: What is the purpose of a financial responsibility agreement during intake?

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

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 4: A patient arrives 30 minutes late for a 15-minute appointment. What is the most appropriate action?

See the patient immediately regardless of impact on other patients
Follow office policy, which may involve rescheduling if the delay disrupts the schedule (Correct answer)
Ask the patient to wait in the lobby indefinitely
Charge the patient a no-show fee and dismiss them

Correct answer: Follow office policy, which may involve rescheduling if the delay disrupts the schedule

Office policy should guide late arrival decisions to balance fairness to all patients while minimizing schedule disruption.

Question 5: What does the term 'legal health record' (LHR) refer to?

Electronic records only, excluding paper documents
The subset of health information that constitutes the official business record for legal and disclosure purposes (Correct answer)
Any document signed by the treating physician
Records subpoenaed by a court

Correct answer: The subset of health information that constitutes the official business record for legal and disclosure purposes

The legal health record is the designated set of documents that represent the official record of patient care and is used for legal, regulatory, and disclosure purposes.

Question 6: Which of the following is an example of a 'credit balance' on a patient account?

The claim was denied and needs resubmission
Patient has not met their deductible
Patient owes $50 after insurance paid
Insurance paid more than the amount billed (Correct answer)

Correct answer: Insurance paid more than the amount billed

A credit balance occurs when a payment exceeds the amount owed, such as when insurance overpays, and may require a refund.

Question 7: An ICD-10-CM code is used in medical billing to describe:

The procedure or service performed
The provider's specialty
The type of insurance plan
The patient's diagnosis or reason for the visit (Correct answer)

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 8: 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
Medical History Form (Correct answer)
Insurance Verification Form

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 9: What is a 'write-off' in medical office accounting?

An amount removed from accounts receivable that cannot be collected (Correct answer)
A charge added to a patient's balance
A payment made to a vendor
A refund issued to a patient

Correct answer: An amount removed from accounts receivable that cannot be collected

A write-off is an amount removed from accounts receivable when it is determined to be uncollectible, such as a contractual adjustment.

Question 10: What is the Stark Law?

Requires all offices to use EHR
Regulates maximum work hours
Sets minimum staffing
Prohibits physician self-referrals to entities where they have a financial relationship, unless exceptions apply (Correct answer)

Correct answer: Prohibits physician self-referrals to entities where they have a financial relationship, unless exceptions apply

The Stark Law prohibits physicians from referring Medicare/Medicaid patients to entities where they or family members have financial interests, with specified exceptions.

Question 11: A patient's plan requires a 'referral' but the patient saw a specialist without one. The claim is denied. Which action best resolves this situation?

Resubmit the claim marked as an emergency visit
Contact the primary care physician to obtain a retroactive referral if allowed by the plan (Correct answer)
File an appeal citing medical necessity without obtaining a referral
Write off the balance and do not bill the patient

Correct answer: Contact the primary care physician to obtain a retroactive referral if allowed by the plan

Some plans allow retroactive referrals; contacting the PCP and the insurer to request one is the correct first step before pursuing other options.

Question 12: The process of verifying a patient's insurance eligibility before a visit is important primarily to:

Avoid billing denials and inform patients of their financial responsibility (Correct answer)
Calculate the provider's reimbursement rate
Select the correct CPT codes
Determine the diagnosis code to use

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.

Question 13: A CMAA is asked to verify a patient's insurance eligibility. Which step should be taken FIRST?

Submit a prior authorization request to the insurer
Ask the billing department to process the claim and wait for a rejection
Contact the patient's pharmacy to confirm coverage
Call or log into the insurance portal to confirm active coverage and benefits (Correct answer)

Correct answer: Call or log into the insurance portal to confirm active coverage and benefits

Verifying eligibility before the appointment — via phone or the payer's online portal — prevents claim denials and ensures the patient understands their coverage in advance.

Question 14: Which report shows the total amount billed, collected, and adjusted for a given period?

Day sheet (daily journal) (Correct answer)
Aging report
Superbill
Encounter form

Correct answer: Day sheet (daily journal)

The day sheet (daily journal) summarizes all financial transactions—charges, payments, and adjustments—for a specific day or period.

Question 15: When posting a Medicare remittance, the CARC code PR-2 indicates:

The provider is not enrolled with Medicare
The claim was sent to the wrong payer
The service was not covered
The patient is responsible for the coinsurance amount (Correct answer)

Correct answer: The patient is responsible for the coinsurance amount

CARC PR-2 (Patient Responsibility – Coinsurance) indicates the balance is the patient's coinsurance obligation.

Question 16: A provider sees a patient on Monday and asks staff to backdate the chart note to the prior Friday. What should the medical administrative assistant do?

Refuse to enter the note at all
Enter the note with today's date and a notation that it is a late entry (Correct answer)
Enter the note under a different patient to avoid confusion
Backdate as requested since the provider has authority

Correct answer: Enter the note with today's date and a notation that it is a late entry

Late entries must be clearly identified with the actual date of entry to maintain accurate and legally defensible medical records.

Question 17: Under HIPAA, a 'covered entity' includes which of the following?

A janitorial service used by a hospital
A patient who shares their own health information
A medical billing company that works independently
A healthcare provider who transmits health information electronically (Correct answer)

Correct answer: A healthcare provider who transmits health information electronically

Covered entities under HIPAA include healthcare providers, health plans, and healthcare clearinghouses that transmit PHI electronically.

Question 18: How long must a covered entity retain HIPAA-related documentation?

10 years
3 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 19: Which of the following BEST describes 'active listening' in a medical office context?

Listening only to the chief complaint and moving on
Nodding while planning your next response
Waiting for the patient to stop talking before speaking
Giving full attention, reflecting back key points, and asking clarifying questions (Correct answer)

Correct answer: Giving full attention, reflecting back key points, and asking clarifying questions

Active listening involves full engagement, paraphrasing, and asking clarifying questions to ensure accurate understanding.

Question 20: What information is typically found on the back of an insurance card?

Claims address and customer service phone number (Correct answer)
Primary care physician name
Copayment for all services
Patient DOB and SSN

Correct answer: Claims address and customer service phone number

The back typically has the claims submission address, customer service number, and provider services phone for verification and claims.

Question 21: Which of the following best describes a superbill in medical billing?

A monthly statement sent to insurance companies
A summary of the patient's annual deductible status
An itemized form listing services, diagnosis codes, and fees for a patient visit (Correct answer)
A document authorizing payment directly to the provider

Correct answer: An itemized form listing services, diagnosis codes, and fees for a patient visit

A superbill is a detailed encounter form capturing CPT and ICD codes plus charges used for claims submission.

Question 22: The suffix '-algia' in a medical term refers to which symptom?

Pain (Correct answer)
Numbness
Bleeding
Swelling

Correct answer: Pain

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

Question 23: Which of the following best describes petty cash in a medical office?

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

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 24: Which document itemizes every service, procedure code, diagnosis code, and charge for a patient visit?

Remittance advice
Ledger card
Aging report
Superbill (encounter form) (Correct answer)

Correct answer: Superbill (encounter form)

The superbill (encounter form) captures all clinical and billing details from a visit and serves as the source document for claim submission.

Question 25: Which of the following best describes a PHI breach in an EHR context?

A provider reviewing records of their own assigned patients
Unauthorized access, use, or disclosure of patient health information (Correct answer)
A scheduled system maintenance outage
A patient requesting and receiving copies of their own records

Correct answer: Unauthorized access, use, or disclosure of patient health information

A PHI breach occurs when protected health information is accessed, used, or disclosed in a manner not permitted under HIPAA, potentially compromising patient privacy.

Question 26: Under OSHA's Bloodborne Pathogens Standard, all used sharps must be:

Placed in a labeled, puncture-resistant sharps container (Correct answer)
Wrapped in gauze and placed in regular trash
Recapped before disposal
Returned to the pharmacy for disposal

Correct answer: Placed in a labeled, puncture-resistant sharps container

OSHA requires used sharps to be disposed of in closeable, puncture-resistant, leak-proof, and labeled biohazard containers.

Question 27: The CMAA should initially be contacted when a patient has two (or more) health insurance.

ask the patient to choose which plan to use.
determine which plans provide primary and secondary (tertiary, etc.) coverage. (Correct answer)
assume both plans will pay for coverage.
determine which plan provides best coverage.

Correct answer: determine which plans provide primary and secondary (tertiary, etc.) coverage.

The CMAA should immediately identify which plan offers primary coverage, which plan offers secondary coverage, and so on when people have two or more health insurance. The CMAA may need to get in touch with the health plans to find out the order of insurance obligation since rules regarding the sequence of payment vary greatly. Double coverage is frequently prohibited, and the patient is frequently unable to make a decision. Private insurances take precedence over Medicaid, while Medicare takes precedence over supplemental insurances.

Question 28: 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?

Premium
Coinsurance (Correct answer)
Allowed Amount
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 29: What is an EOB used for in the insurance processing workflow?

Obtain prior authorization
Submit initial claims
Verify eligibility before appointments
Reconcile insurance payments and identify patient responsibility (Correct answer)

Correct answer: Reconcile insurance payments and identify patient responsibility

The EOB reconciles insurance payments by comparing billed amounts, allowed amounts, payments, and patient responsibility.

Question 30: What does 'purging' mean in medical records management?

Removing inactive records from active filing per retention policies (Correct answer)
Transferring to a new EHR
Shredding all records over one year
Deleting all electronic records

Correct answer: Removing inactive records from active filing per retention policies

Purging removes inactive records from active filing, transferring them to storage or destroying per the retention schedule.

Question 31: Which federal program offered financial incentives to eligible professionals who adopted and demonstrated meaningful use of certified EHR technology?

Stark Law exemption
Medicare and Medicaid EHR Incentive Programs (Correct answer)
CLIA waiver program
HIPAA Security Rule

Correct answer: Medicare and Medicaid EHR Incentive Programs

The Medicare and Medicaid EHR Incentive Programs (later renamed Promoting Interoperability) provided payments to eligible professionals and hospitals for adopting and meaningfully using certified EHR technology.

Question 32: The combining form 'oste/o' refers to which body structure?

Tendon
Cartilage
Muscle
Bone (Correct answer)

Correct answer: Bone

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

Question 33: Which scheduling method books multiple patients at the same appointment start time?

Cluster scheduling
Double-booking
Wave scheduling (Correct answer)
Open-access scheduling

Correct answer: Wave scheduling

Wave scheduling books several patients at the top of each hour, allowing flexibility for varying visit lengths.

Question 34: Which abbreviation on a prescription means 'twice a day'?

QD
BID (Correct answer)
TID
QID

Correct answer: BID

BID stands for 'bis in die,' a Latin phrase meaning twice a day.

Question 35: Which ICD coding system is currently required for diagnosis coding in the United States?

ICD-10-CM (Correct answer)
DSM-5
ICD-9-CM
ICD-11-CM

Correct answer: ICD-10-CM

ICD-10-CM has been mandated for diagnosis coding in the US since October 1, 2015.

Question 36: What is the purpose of a patient ledger?

Scheduling patient appointments
Recording employee wages
Tracking an individual patient's charges, payments, and balance (Correct answer)
Documenting clinical notes

Correct answer: Tracking an individual patient's charges, payments, and balance

A patient ledger is a record that tracks all financial transactions (charges, payments, adjustments) for an individual patient account.

Question 37: What does the prefix 'brady-' mean in medical terminology?

Slow (Correct answer)
Fast
Small
Large

Correct answer: Slow

The prefix 'brady-' means slow, as seen in bradycardia (slow heart rate).

Question 38: Which of the following vaccination records should be maintained for staff in a medical office?

Vaccinations are not required for administrative staff
Hepatitis B and annual influenza vaccinations at minimum (Correct answer)
Only vaccines required for travel
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 39: Under HIPAA, which of the following is considered a 'covered entity'?

A health insurance plan that pays for medical services (Correct answer)
A medical equipment manufacturer
A software vendor selling EHR systems
A medical billing company hired by a clinic

Correct answer: A health insurance plan that pays for medical services

Covered entities under HIPAA include health plans, healthcare clearinghouses, and healthcare providers who transmit health information electronically.

Question 40: Which of the following is the proper procedure for correcting an error in a patient's paper medical record?

Use a black marker to completely cover the incorrect entry and write the correction in the margin.
Remove the page containing the error and replace it with a new, corrected page.
Draw a single line through the incorrect entry, write "corr." or "error," add the correct information, and then initial and date the change. (Correct answer)
Completely obscure the error using correction fluid and write the correct information on top.

Correct answer: Draw a single line through the incorrect entry, write "corr." or "error," add the correct information, and then initial and date the change.

The legally accepted method for correcting an error in a paper medical record is to draw a single line through the original entry so that it remains legible. The person making the correction should then add the correct information, initial or sign it, and date it. This ensures a clear and transparent audit trail.

Question 41: Which of the following code sets would be used to bill for durable medical equipment (DME), such as a walker or hospital bed, for a Medicare patient?

ICD-10-CM
ICD-10-PCS
HCPCS Level II (Correct answer)
CPT® Category II

Correct answer: HCPCS Level II

HCPCS Level II codes are used to report products, supplies, and services not included in the CPT® code set, such as ambulance services, durable medical equipment (DME), prosthetics, and certain drugs. ICD-10-CM codes are for diagnoses, ICD-10-PCS is for inpatient procedures, and CPT® Category II codes are for performance measurement.

Question 42: How should written communication be adapted for patients with low health literacy?

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

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 43: What is a Health Information Exchange (HIE)?

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

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

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

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 45: How should confidential staff conversations about patient care take place?

Through text messages on personal phones
In a private area away from patients, using minimum necessary information (Correct answer)
In the waiting room
At the front desk for easy access

Correct answer: In a private area away from patients, using minimum necessary information

Patient care discussions should occur privately where they cannot be overheard, using only minimum necessary information.

Question 46: What does the abbreviation 'Dx' stand for in a medical chart?

Drug
Diagnosis (Correct answer)
Discharge
Dosage

Correct answer: Diagnosis

'Dx' is the standard medical abbreviation for diagnosis.

Question 47: A medical administrative assistant notices that a colleague has been accessing patient records for individuals who are not that colleague's assigned patients. The BEST first action is to:

Warn the colleague directly
Ignore it since it may be for legitimate training
Report the observed behavior to the privacy officer or supervisor (Correct answer)
Immediately revoke the colleague's EHR access

Correct answer: Report the observed behavior to the privacy officer or supervisor

Suspected unauthorized access to PHI should be reported to the privacy officer or supervisor so a proper investigation can be conducted in accordance with the organization's policies.

Question 48: What is the purpose of a prior authorization in healthcare?

To authorize a provider to accept new patients
To verify a patient's eligibility on the date of service
To confirm a patient's identity before treatment
To obtain insurer approval before certain services or medications are provided (Correct answer)

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 49: Which model of care delivery groups doctors, hospitals, and other providers together to coordinate care and share financial accountability for quality outcomes?

Health Reimbursement Arrangement (HRA)
Accountable Care Organization (ACO) (Correct answer)
Exclusive Provider Organization (EPO)
Preferred Provider Organization (PPO)

Correct answer: Accountable Care Organization (ACO)

An ACO is a network of providers who voluntarily coordinate patient care and share in savings (or losses) tied to quality metrics and cost targets, primarily under Medicare programs. This distinguishes it from PPOs and EPOs, which are insurance network structures.

Question 50: What does the combining form 'cardi/o' refer to?

Lungs
Liver
Heart (Correct answer)
Brain

Correct answer: Heart

Cardi/o is the combining form for heart, used in terms like cardiology and cardiomyopathy.

Question 51: The abbreviation 'NPP' in HIPAA compliance refers to:

Notice of Privacy Practices (Correct answer)
National Provider Prefix
New Patient Protocol
Non-Participating Provider

Correct answer: Notice of Privacy Practices

NPP stands for Notice of Privacy Practices, the document that informs patients how their protected health information (PHI) may be used and disclosed.

Question 52: To minimize supply shortages without requiring a full office closure for counting, which inventory approach is considered BEST practice for a medical office?

Using a perpetual inventory system with regular cycle counts to maintain ongoing accuracy (Correct answer)
Counting all supplies once per year during a scheduled office closure
Having each provider track and order their own individual supplies
Relying solely on vendor invoices to estimate current stock levels

Correct answer: Using a perpetual inventory system with regular cycle counts to maintain ongoing accuracy

A perpetual inventory system continuously tracks stock levels as items are used and received. Cycle counts — counting a rotating subset of items on a schedule — keep the system accurate without requiring a full shutdown. This approach reduces shortages and discrepancies while minimizing disruption to practice operations.

Question 53: A practice's accounts receivable (A/R) days outstanding is 65 days. What does this indicate?

Insurance pays within 65 hours of claim submission
The practice has 65 unpaid claims
On average, it takes 65 days to collect payment after a service is rendered (Correct answer)
The practice collects payment faster than average

Correct answer: On average, it takes 65 days to collect payment after a service is rendered

A/R days outstanding measures the average number of days it takes to collect payment; 65 days is above the industry benchmark of 30–45 days and may signal billing inefficiencies.

Question 54: What should be included in a specialist referral?

Demographics, insurance, clinical reason, relevant history, diagnostic results, and referring provider info (Correct answer)
Just the physician's letter
Only name and insurance
Entire medical record from birth

Correct answer: Demographics, insurance, clinical reason, relevant history, diagnostic results, and referring provider info

A complete referral includes demographics, insurance/authorization, referral reason, relevant history, test results, and provider contacts.

Question 55: What is the significance of professional networking for CMAAs?

No value for administrative roles
Career advancement, CE resources, industry updates, and peer support (Correct answer)
Only useful for physicians and nurses
Only useful for finding new jobs

Correct answer: Career advancement, CE resources, industry updates, and peer support

Networking provides career development, continuing education access, industry awareness, peer support, and enhanced reputation.

Question 56: A patient calls to dispute a charge on their Explanation of Benefits (EOB). Which document should the medical administrative assistant reference first to verify the billed service?

The patient's insurance card
The superbill or encounter form from the visit (Correct answer)
The office's fee schedule master list
The provider's credentialing file

Correct answer: The superbill or encounter form from the visit

The superbill (encounter form) is the source document that captures the diagnosis and procedure codes billed for a specific visit, making it the first reference when verifying or disputing a charge.

Question 57: How does quality improvement apply to the CMAA role?

CMAAs track metrics like wait times, denial rates, and satisfaction, identifying process improvements (Correct answer)
Means doing the same tasks faster
Exclusively management's responsibility
Only applies to clinical care

Correct answer: CMAAs track metrics like wait times, denial rates, and satisfaction, identifying process improvements

CMAAs contribute to QI by tracking operational and financial metrics, identifying inefficiencies, and implementing improvements.

Question 58: What is the difference between a deductible and a copayment?

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

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 59: Which suffix indicates a condition of pain?

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

Correct answer: -algia

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

Question 60: Which of the following is an example of a physical safeguard required under the HIPAA Security Rule?

Installing antivirus software on workstations
Encrypting data transmitted over the internet
Implementing audit controls to track ePHI access
Using locked cabinets or restricted-access areas for workstations containing ePHI (Correct answer)

Correct answer: Using locked cabinets or restricted-access areas for workstations containing ePHI

Physical safeguards include facility access controls, workstation security, and device and media controls — such as locked areas — to protect ePHI from unauthorized physical access.

Question 61: A medical office schedules four patients to arrive at the top of the hour. They are then seen by the provider on a first-come, first-served basis. This method of scheduling is known as:

Wave scheduling (Correct answer)
Modified wave scheduling
Time-specified scheduling
Double-booking

Correct answer: Wave scheduling

Wave scheduling involves having several patients arrive at the same time, typically at the top of the hour, and then seeing them in the order of their arrival. This method is designed to handle no-shows and ensure the provider always has a patient ready to be seen, though it can lead to increased wait times.

Question 62: A data entry error is found in a billing record after claim submission. What should the CMAA do?

Wait for denial then fix
Contact the payer/clearinghouse to correct or void, submit corrected claim, document the error (Correct answer)
Ignore it since the claim was sent
Delete entire billing record

Correct answer: Contact the payer/clearinghouse to correct or void, submit corrected claim, document the error

Proactively contact the payer or clearinghouse to void or correct the claim, submit an accurate corrected claim, and document everything.

Question 63: Which term describes the amount a patient must pay out-of-pocket before insurance begins covering costs?

Deductible (Correct answer)
Copayment
Coinsurance
Premium

Correct answer: Deductible

A deductible is the annual amount a patient must pay out-of-pocket before their insurance plan begins paying.

Question 64: Which standard electronic transaction is used for insurance eligibility verification?

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

Correct answer: ANSI 270/271

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

Question 65: When a medical practice transitions from paper records to an EHR system, which step is most critical before the system goes live?

Immediately shredding all paper records on the first day of EHR use
Thoroughly training all staff on the new system prior to implementation (Correct answer)
Restricting EHR access to physicians only during the initial rollout period
Disabling internet connectivity on all workstations during the transition

Correct answer: Thoroughly training all staff on the new system prior to implementation

Comprehensive staff training before EHR go-live is essential to ensure accurate data entry, patient safety, workflow continuity, and compliance with documentation standards from day one.

Question 66: Which legal doctrine holds physicians responsible for their employees' actions?

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

Correct answer: Respondeat superior

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

Question 67: Which scheduling method alternates between scheduled patients and open slots for walk-ins?

Modified wave scheduling (Correct answer)
Open access scheduling
Wave scheduling
Stream scheduling

Correct answer: Modified wave scheduling

Modified wave scheduling schedules patients at the beginning of each hour with remaining time open for walk-ins and catch-up.

Question 68: Which scheduling method groups patients with similar conditions or needs into the same time block?

Cluster scheduling (Correct answer)
Double-booking
Wave scheduling
Open scheduling

Correct answer: Cluster scheduling

Cluster scheduling groups patients with similar needs (e.g., all diabetic checks together) to improve workflow efficiency.

Question 69: Which CPT code range is designated for Evaluation and Management (E/M) services?

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

Correct answer: 99201-99499

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

Question 70: What kind of health insurance compensates for loss or harm by predetermined payments rather than medical services?

accident and health insurance.
liability insurance.
no-fault auto insurance.
indemnity insurance. (Correct answer)

Correct answer: indemnity insurance.

Instead of paying for medical care, indemnity insurance makes predefined payouts for losses or damages.

Question 71: What continuing education does a CMAA need for certification renewal?

None required
10 credits within a 2-year cycle (Correct answer)
Medical school courses for one semester
Full exam retake annually

Correct answer: 10 credits within a 2-year cycle

CMAAs must complete 10 CE credits every two years through approved courses, seminars, conferences, or training programs.

Question 72: Under the Affordable Care Act, how long can a dependent child remain on a parent's health insurance plan?

Until age 18
Until age 26 (Correct answer)
Until age 25 or marriage, whichever comes first
Until age 21

Correct answer: Until age 26

The ACA requires health plans that cover dependents to allow children to remain on a parent's plan until age 26, regardless of student or marital status.

Question 73: Which form is used to submit physician service claims to Medicare?

ADA Dental Claim Form
CMS-1500 (Correct answer)
UB-04 (CMS-1450)
Workers' Compensation First Report

Correct answer: CMS-1500

The CMS-1500 is the standard claim form for professional outpatient services to Medicare and most payers.

Question 74: Which of the following documents, required by HIPAA, must be provided to patients to inform them about how their protected health information (PHI) will be used and disclosed?

Assignment of Benefits (AOB)
Release of Information (ROI)
Notice of Privacy Practices (NPP) (Correct answer)
Advance Directive

Correct answer: Notice of Privacy Practices (NPP)

The HIPAA Privacy Rule requires most healthcare providers to develop and distribute a Notice of Privacy Practices (NPP). This document explains to patients their rights concerning their PHI and details how the medical office may use and disclose their information for treatment, payment, and healthcare operations.

Question 75: Which of the following is an example of a 'clean claim'?

A claim with all required fields accurately completed on first submission (Correct answer)
A claim submitted with an expired authorization number
A claim missing the patient's date of birth
A claim for a non-covered service

Correct answer: A claim with all required fields accurately completed on first submission

A clean claim contains all required, accurate information and passes all edits, allowing the payer to process it without requesting additional information.

Question 76: 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 77: Which of the following is a key clinical advantage of EHRs over traditional paper records?

Automatic elimination of all data entry errors
Removal of the need for physician documentation
No initial setup cost or staff training required
Immediate access to complete patient information across multiple care locations (Correct answer)

Correct answer: Immediate access to complete patient information across multiple care locations

EHRs allow authorized providers to access a patient's complete health information instantly from any location, improving care coordination and decision-making.

Question 78: The term 'superbill' in a medical office refers to:

A charge slip listing services rendered, diagnosis codes, and procedure codes used for billing (Correct answer)
A bill sent to a secondary insurance after primary denial
An unusually large patient invoice
A summary of a patient's annual healthcare costs

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 79: A patient requests that their medical records not be shared with their adult children. Under HIPAA, the medical office must:

Share records with family if they are listed as emergency contacts
Require the patient to submit the request in writing before honoring it
Honor the patient's request and restrict disclosure to the adult children (Correct answer)
Disclose records to immediate family members regardless of patient wishes

Correct answer: Honor the patient's request and restrict disclosure to the adult children

HIPAA grants competent adult patients the right to restrict who receives their health information, including family members.

Question 80: Under HIPAA, which is considered Protected Health Information (PHI)?

General health tips on a clinic website
A patient's favorite color
A medical record number linked to a diagnosis (Correct answer)
De-identified statistical data

Correct answer: A medical record number linked to a diagnosis

PHI includes any individually identifiable health information, such as a medical record number linked to a diagnosis.

Question 81: When a patient with a language barrier calls to schedule an appointment, what is the most appropriate action?

Ask the patient to call back with an English-speaking family member
Use an interpreter service or bilingual staff to assist with scheduling (Correct answer)
Schedule the appointment without gathering complete information
Decline to schedule and refer to another facility

Correct answer: Use an interpreter service or bilingual staff to assist with scheduling

Federal law (Title VI) requires meaningful access for patients with limited English proficiency, which includes using interpreter services.

Question 82: What does CPOE stand for in the context of EHR systems?

Computerized Physician Order Entry (Correct answer)
Continuous Patient Outcome Examination
Certified Provider Order Enforcement
Clinical Practice Outcomes Evaluation

Correct answer: Computerized Physician Order Entry

CPOE (Computerized Physician Order Entry) is an EHR feature that allows providers to enter orders—such as medications, labs, and imaging—directly into the electronic system, reducing errors from handwritten orders.

Question 83: What is a co-pay?

The insurance premium payment
The total cost of a medical procedure
A fixed amount a patient pays at each visit (Correct answer)
The annual deductible amount

Correct answer: A fixed amount a patient pays at each visit

A co-pay is a fixed out-of-pocket amount a patient pays at each medical visit, as defined by their insurance plan.

Question 84: A CMAA is setting up the appointment schedule for the next quarter. The provider, Dr. Smith, has a standing meeting every Tuesday from 1:00 PM to 2:00 PM. How should the CMAA account for this on the schedule?

Leave the schedule open for walk-ins
Schedule only brief, follow-up appointments
Create a matrix with that time blocked off (Correct answer)
Double-book patients during that hour

Correct answer: Create a matrix with that time blocked off

A scheduling matrix is a grid that outlines provider availability and unavailability. The CMAA should block off the time Dr. Smith is in a meeting to prevent any appointments from being scheduled during that period, ensuring the schedule accurately reflects the provider's availability.

Question 85: Which code set is used to report supplies, durable medical equipment, and services not covered by CPT codes for Medicare billing?

HCPCS Level II (Correct answer)
CDT codes
Revenue codes
ICD-10-PCS

Correct answer: HCPCS Level II

HCPCS Level II codes (alphanumeric, starting with A–V) are used to bill Medicare and Medicaid for supplies, DME, injections, and other services not in CPT.

Question 86: A physician refers a patient to a specialist. Which document typically accompanies the referral to provide the specialist with relevant background?

Superbill
Advance beneficiary notice (ABN)
Referral letter with pertinent medical records (Correct answer)
Remittance advice

Correct answer: Referral letter with pertinent medical records

A referral letter along with relevant records—history, labs, imaging—gives the specialist the context needed to evaluate the patient.

Question 87: When scheduling a follow-up appointment, a patient mentions they have a new insurance plan. What should the assistant do first?

Ask the patient to contact their old insurer to transfer records
Collect the new insurance card information and verify eligibility before the visit (Correct answer)
Reschedule the appointment until insurance is confirmed
Proceed with scheduling and update insurance at the next visit

Correct answer: Collect the new insurance card information and verify eligibility before the visit

Collecting and verifying the new insurance information ensures accurate billing and prevents claim denials.

Question 88: A medical administrative assistant discovers a billing error where a patient was overcharged. What is the correct next step?

Ignore the error if it was already paid by insurance
Adjust the charge in the system without creating a paper trail
Document the error and notify the billing supervisor or practice manager immediately (Correct answer)
Refund the patient without telling the provider

Correct answer: Document the error and notify the billing supervisor or practice manager immediately

Billing errors must be reported to the appropriate supervisor and corrected with proper documentation to maintain compliance.

Question 89: Under the HIPAA Privacy Rule, which of the following uses of PHI does NOT require patient authorization?

Selling PHI to a pharmaceutical research company
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
Using PHI for marketing a new prescription drug

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

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

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

Leaning slightly forward to show interest
Maintaining appropriate eye contact
Nodding to acknowledge understanding
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 92: When a colleague repeatedly interrupts you during team meetings, the MOST professional approach is to:

Complain to the office manager immediately
Stop contributing to meetings altogether
Address the behavior privately and respectfully after the meeting (Correct answer)
Interrupt them back to assert yourself

Correct answer: Address the behavior privately and respectfully after the meeting

Addressing interpersonal issues privately and respectfully avoids public conflict and preserves working relationships.

Question 93: What does 'balance billing' mean?

Sending bills at the end of each month
Balancing the daily transaction log
Billing the insurance company first
Billing the patient for the difference between the provider's charge and the insurer's payment (Correct answer)

Correct answer: Billing the patient for the difference between the provider's charge and the insurer's payment

Balance billing occurs when a provider bills the patient for the difference between their charge and what the insurance company paid.

Question 94: Which type of health insurance plan requires patients to select a primary care physician (PCP) who must provide referrals before the patient can see a specialist?

Preferred Provider Organization (PPO)
Fee-for-Service (Indemnity) plan
High-Deductible Health Plan (HDHP)
Health Maintenance Organization (HMO) (Correct answer)

Correct answer: Health Maintenance Organization (HMO)

HMO plans use a 'gatekeeper' model in which the designated PCP coordinates all care and must issue a referral before the insurer will cover specialist visits. PPOs allow direct access to specialists at a higher out-of-pocket cost, and indemnity plans impose no network restrictions.

Question 95: A provider performs a procedure that is justified by the patient's documented signs and symptoms and follows accepted standards of medicine. This concept, which is critical for reimbursement, is known as:

Revenue cycle management
Coordination of benefits
Medical necessity (Correct answer)
Informed consent

Correct answer: Medical necessity

Medical necessity is the principle that healthcare services or supplies are reasonable, necessary, and appropriate for the diagnosis or treatment of an illness, injury, or condition, and meet the standards of good medical practice. Payers will deny claims if they do not deem the services provided to be medically necessary.

Question 96: Which task falls within the CMAA scope of practice?

Interpreting test results
Drawing blood
Administering injections
Processing insurance claims and posting payments (Correct answer)

Correct answer: Processing insurance claims and posting payments

Processing insurance claims is an administrative function within CMAA scope; clinical tasks are not.

Question 97: What is the purpose of a superbill in a medical office?

To schedule follow-up appointments
To document diagnoses and procedures for billing (Correct answer)
To record insurance eligibility
To track employee payroll hours

Correct answer: To document diagnoses and procedures for billing

A superbill lists diagnoses, procedures, and services from a patient visit, serving as the basis for claim submission.

Question 98: What information is required on a patient receipt in a medical office?

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

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 99: What are the ethical precepts that dictate that decisions should be made with the benefit of the patient in mind?

justice.
beneficence. (Correct answer)
maleficence.
autonomy.

Correct answer: beneficence.

The principle of beneficence dictates that decisions must be made with the patient's best interests in mind.

Question 100: A patient who is both Medicare and Medicaid eligible is called a:

Crossover patient
Bridge patient
Dual-eligible beneficiary (Correct answer)
Supplemental enrollee

Correct answer: Dual-eligible beneficiary

Individuals who qualify for both Medicare and Medicaid are officially called dual-eligible beneficiaries, with Medicare serving as primary payer.

Question 101: A patient has both Medicare and employer commercial insurance. Which is typically primary?

Patient chooses which is primary
Commercial plan is primary if employer has 20+ employees (Correct answer)
Plan with lower premium is primary
Medicare is always primary

Correct answer: Commercial plan is primary if employer has 20+ employees

Under Medicare Secondary Payer rules, the employer plan is primary if the employer has 20+ employees for aged beneficiaries.

Question 102: What is the purpose of a 'remittance advice' (RA) sent by an insurance payer?

To notify the patient of their out-of-pocket responsibility
To authorize future procedures for a specific patient
To explain how each claim was adjudicated, including payment amounts and denial reasons (Correct answer)
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 103: What is the advantage of an online patient scheduling portal?

Removes need for confirmation processes
Patients book at their convenience, reducing phone volume and improving efficiency (Correct answer)
Guarantees no missed appointments
Eliminates need for front desk staff

Correct answer: Patients book at their convenience, reducing phone volume and improving efficiency

Online portals allow 24/7 booking, reduce call volume, give patients control, and improve scheduling efficiency.

Question 104: A patient insists on speaking directly with the physician to schedule a procedure. What should the medical administrative assistant do?

Refuse the request and end the call
Immediately transfer the call without screening
Schedule the procedure without consulting the physician's availability
Explain the scheduling process, collect necessary information, and offer to have the physician return the call if clinically needed (Correct answer)

Correct answer: Explain the scheduling process, collect necessary information, and offer to have the physician return the call if clinically needed

Professional intake procedures should be followed, with physician callback offered only when clinically warranted to protect the provider's time.

Question 105: Which exemplifies the HIPAA minimum necessary standard?

Allowing all staff full access to every record
Sharing complete histories with every department
Giving billing staff only financial data needed for claims (Correct answer)
Posting schedules in the waiting room

Correct answer: Giving billing staff only financial data needed for claims

The minimum necessary standard limits PHI access to only what is needed for the intended purpose.

Question 106: When a physician is temporarily unavailable to see scheduled patients, the CMAA should FIRST:

Notify waiting patients of the delay and offer to reschedule if needed (Correct answer)
Direct all patients to the nearest emergency room
Cancel all appointments for the day without notifying patients
Have the front-desk staff perform patient triage

Correct answer: Notify waiting patients of the delay and offer to reschedule if needed

Proactively communicating delays and offering rescheduling options respects patients' time and maintains a professional environment.

Question 107: The term 'fee schedule' in a medical office refers to:

The insurer's reimbursement history
The set charges for each service or procedure provided by the practice (Correct answer)
A payment plan offered to uninsured patients
A list of employees' wages

Correct answer: The set charges for each service or procedure provided by the practice

A fee schedule lists the practice's standard charges for each CPT-coded service before any insurance adjustment is applied.

Question 108: When documenting a phone conversation with a patient in the medical record, the entry should include:

Only the patient's name and the date
The patient's financial information for billing reference
Date, time, your name, nature of the call, and actions taken or instructions given (Correct answer)
A summary written in medical slang for brevity

Correct answer: Date, time, your name, nature of the call, and actions taken or instructions given

Thorough documentation of phone encounters creates a legal and clinical record of the interaction and follow-up.

Question 109: A patient requests a copy of their own medical records. Under HIPAA, the practice must generally fulfill this request within how many days?

90 days
10 days
30 days (Correct answer)
60 days

Correct answer: 30 days

HIPAA's Privacy Rule requires covered entities to provide access to records within 30 days, with one 30-day extension if needed.

Question 110: Which form is used to submit claims to Medicare and most commercial insurers?

HCFA-99
ADA Dental Claim Form
UB-04
CMS-1500 (Correct answer)

Correct answer: CMS-1500

The CMS-1500 is the standard paper claim form used by non-institutional providers to bill Medicare, Medicaid, and most commercial insurers.

Question 111: 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 112: Why is emergency contact information collected during registration?

To notify someone in case of a medical emergency (Correct answer)
To market to additional patients
To bill someone if patient doesn't pay
To verify identity through a third party

Correct answer: To notify someone in case of a medical emergency

Emergency contact enables the practice to reach a designated person if the patient experiences a medical emergency.

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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