CMAA Financial Management and Accounting 4 — Questions and Answers
Question 1: A patient's EOB shows a $150 contractual adjustment. What does this mean?
- The patient owes an additional $150
- The provider wrote off $150 as part of their payer contract (Correct answer)
- The insurance company denied the $150 charge
- The patient already paid $150
Correct answer: The provider wrote off $150 as part of their payer contract
A contractual adjustment is the amount a provider agrees to write off based on their negotiated contract with the insurance payer.
Question 2: Which report shows the total amount billed, collected, and adjusted for a given period?
- Aging report
- Day sheet (daily journal) (Correct answer)
- Encounter form
- Superbill
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 3: A claim is denied because the procedure is 'not medically necessary.' What is the FIRST step?
- Write off the balance immediately
- Request an itemized bill from the provider
- Review documentation and file an appeal with supporting clinical notes (Correct answer)
- Re-bill the patient for the full amount
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 4: What is the purpose of a remittance advice (RA)?
- To notify the patient of their appointment balance
- To inform the provider of claim payment decisions and any adjustments made (Correct answer)
- To request additional documentation from the provider
- To transfer the patient's account to collections
Correct answer: To inform the provider of claim payment decisions and any adjustments made
A remittance advice explains which claims were paid, denied, or adjusted and provides the reasons for each decision.
Question 5: Which of the following is an example of accounts payable in a medical office?
- Patient copayments collected at check-in
- Outstanding insurance claims awaiting payment
- An unpaid invoice for medical supplies ordered from a vendor (Correct answer)
- A refund owed to a patient who overpaid
Correct answer: An unpaid invoice for medical supplies ordered from a vendor
Accounts payable refers to money the practice owes to outside vendors or suppliers for goods and services received.
Question 6: When posting a payment from Medicare, the CMAA notices the payment is less than expected. What should be checked first?
- The patient's employment history
- The Medicare fee schedule for that procedure code (Correct answer)
- The office's overhead budget
- The physician's license renewal date
Correct answer: The Medicare fee schedule for that procedure code
Comparing the payment to the Medicare fee schedule helps determine if the payment is correct or if an error or denial has occurred.
Question 7: A patient has a $500 deductible, has met $300 so far, and receives a $400 service. How much of this visit applies to the deductible?
- $400
- $300
- $200 (Correct answer)
- $100
Correct answer: $200
The patient still needs $200 more to meet the $500 deductible ($500 − $300 = $200), so $200 of the $400 service applies to the deductible.
CMAA Financial Management and Accounting 4
A patient's EOB shows a $150 contractual adjustment.
What does this mean?