CMAS Insurance Verification & Prior Authorization

Question 1

What is the primary purpose of insurance verification in a medical office?

Accepted Answer

To confirm the patient has active coverage and understand their benefits before services are rendered

Answer

Insurance verification confirms active coverage, deductibles, copays, and covered services so the office can inform the patient of their financial responsibility before treatment.

Question 2

Which document does an insurance company send to a patient and provider summarizing how a claim was processed and what the patient owes?

Accepted Answer

Explanation of Benefits (EOB)

Answer

An Explanation of Benefits (EOB) details the services billed, the amount allowed, what insurance paid, and the patient's remaining responsibility.

Question 3

What does Coordination of Benefits (COB) determine when a patient has two insurance plans?

Accepted Answer

Which insurance plan pays first and how much the secondary plan will contribute

Answer

COB rules determine the order in which multiple insurance plans pay to prevent overpayment and ensure combined payments do not exceed 100% of the allowed amount.

Question 4

Prior authorization (precertification) is MOST commonly required for which type of service?

Accepted Answer

Elective surgeries and specialty referrals

Answer

Insurers require prior authorization for non-urgent or elective procedures and specialist services to verify medical necessity before approving coverage.

Question 5

When verifying a patient's insurance, which of the following pieces of information is MOST critical to collect?

Accepted Answer

The group number, member ID, effective date, and copay/deductible amounts

Answer

Group number, member ID, effective/termination dates, and cost-sharing details (copay, deductible, coinsurance) are essential to determine active coverage and patient liability.

(CMAS) Certified Medical Administrative Specialist Practice Test

(CMAS) Certified Medical Administrative Specialist Practice Test

CMAS Insurance Verification & Prior Authorization