CMAA Insurance Verification and Processing 2

Question 1

What is the primary purpose of verifying insurance eligibility before an appointment?

Accepted Answer

To ensure the practice will receive payment

Answer

Eligibility verification confirms active coverage and that planned services will be covered, ensuring proper reimbursement.

Question 2

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

Accepted Answer

Claims address and customer service phone number

Answer

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

Question 3

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

Accepted Answer

Commercial plan is primary if employer has 20+ employees

Answer

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

Question 4

What does 'prior authorization' mean in insurance processing?

Accepted Answer

Insurance must approve certain services before they are performed

Answer

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

Question 5

What is a referral in managed care insurance plans?

Accepted Answer

An authorization from the PCP for the patient to see a specialist

Answer

In managed care, a referral is PCP authorization directing the patient to a specialist within the plan's network.

CMAA - Certified Medical Administrative Assistant Practice Test