CMAA Healthcare Systems, Settings, and the Healthcare Team

Question 1

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?

Accepted Answer

Health Maintenance Organization (HMO)

Answer

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 2

What is the primary purpose of accreditation by an organization such as The Joint Commission (TJC)?

Accepted Answer

To evaluate healthcare organizations against quality and safety standards and certify compliance

Answer

Accreditation bodies like The Joint Commission assess whether healthcare facilities meet established quality, safety, and operational standards. Accreditation is separate from licensure (a state function) and has no role in setting fees or negotiating insurance contracts.

Question 3

In a medical practice, which team member is primarily responsible for diagnosing conditions and ordering treatments?

Accepted Answer

Licensed physician or advanced practice provider (APP)

Answer

Diagnosing conditions and ordering treatments falls within the clinical scope of licensed physicians and advanced practice providers (nurse practitioners, physician assistants). Administrative and billing staff have separate, non-clinical roles.

Question 4

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

Accepted Answer

Accountable Care Organization (ACO)

Answer

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 5

A medical administrative assistant verifying that a newly hired physician's education, training, and licensure meet the required standards is performing which process?

Accepted Answer

Credentialing

Answer

Credentialing is the formal process of collecting and verifying a provider's qualifications — including degrees, training programs, board certifications, and licenses — before they are authorized to practice at a facility or be enrolled with payers. Privileging is a related but distinct step that grants specific clinical permissions after credentialing is complete.

CMAA - Certified Medical Administrative Assistant Practice Test

CMAA - Certified Medical Administrative Assistant Practice Test

CMAA Healthcare Systems, Settings, and the Healthcare Team