CMAS Case Analysis & Practical Application 3

Question 1

A patient with Medicare Part B is also covered by a large employer group plan. Which plan is the primary payer?

Accepted Answer

The employer group plan is primary because the employer has 20 or more employees

Answer

When a Medicare patient is covered by an employer group plan with 20+ employees, the group plan is primary per Medicare Secondary Payer (MSP) rules.

Question 2

A claim is denied with remark code CO-4 (the procedure code is inconsistent with the modifier). Which corrective action is appropriate?

Accepted Answer

Review the procedure code and modifier pairing, correct the inconsistency, and resubmit a corrected claim

Answer

CO-4 indicates a coding error; the claim must be corrected before resubmission to resolve the denial.

Question 3

During patient check-in, you discover the patient's address and phone number on file are two years old. What is the best practice?

Accepted Answer

Verify and update demographic information at every visit to ensure accurate billing and communication

Answer

Updating demographics at each visit reduces claim rejections from incorrect information and ensures proper patient contact.

Question 4

A patient's surgery is scheduled for next week but their insurance authorization covers only office visits. What should be done immediately?

Accepted Answer

Contact the insurance company to obtain a separate prior authorization specifically for the surgical procedure

Answer

Surgical procedures typically require specific prior authorization separate from office visit coverage.

Question 5

A patient requests copies of their medical records and you notice a psychotherapy note in the file. Under HIPAA, how are psychotherapy notes treated?

Accepted Answer

Psychotherapy notes have special protections and generally require separate, specific authorization to release

Answer

HIPAA grants psychotherapy notes extra protection beyond standard PHI, requiring specific patient authorization for most disclosures.

(CMAS) Certified Medical Administrative Specialist Practice Test