NCMA Medical Office Administration and Billing

Question 1

What does ICD-10-CM stand for, and what is its primary purpose in medical billing?

Accepted Answer

International Classification of Diseases, 10th revision, Clinical Modification; used to classify and code diagnoses

Answer

ICD-10-CM is the International Classification of Diseases, 10th revision, Clinical Modification — the U.S. standard coding system used to classify diagnoses, symptoms, and conditions for insurance billing, statistical analysis, and clinical documentation.

Question 2

What is the purpose of the superbill (encounter form) in a medical office?

Accepted Answer

A comprehensive form listing services rendered, diagnoses, and charges used to generate insurance claims

Answer

The superbill (also called an encounter form or charge ticket) is an itemized document generated at each patient visit listing CPT procedure codes, ICD-10 diagnosis codes, charges, and provider information — used as the source document for insurance claim submission.

Question 3

Which of the following best defines the term 'co-insurance' in health insurance?

Accepted Answer

The percentage of covered medical costs the patient pays after meeting the deductible

Answer

Co-insurance is the percentage of medical costs the patient is responsible for paying after the deductible has been met. For example, with an 80/20 plan, insurance pays 80% and the patient pays 20% (co-insurance).

Question 4

What is a Prior Authorization (PA) and when is it required?

Accepted Answer

Advance approval from the insurance company required before certain procedures, medications, or referrals can be covered

Answer

Prior authorization is a pre-approval from a patient's insurance company that must be obtained before specific services, procedures, specialist referrals, or medications will be covered. Without PA, the claim may be denied.

Question 5

When scheduling patient appointments, which scheduling system gives each appointment a fixed time slot and tends to minimize waiting room time?

Accepted Answer

Stream (fixed interval) scheduling

Answer

Stream scheduling (also called fixed interval or time-specified scheduling) assigns each patient a specific appointment time at regular intervals (e.g., every 15–30 minutes). When followed, it minimizes patient wait times.

NCMA - National Certified Medical Assistant Practice Test

NCMA - National Certified Medical Assistant Practice Test

NCMA Medical Office Administration and Billing