Specialty Certified Medical Assistant Medical Office Administration and Billing

Question 1

What is the purpose of an Explanation of Benefits (EOB) document?

Accepted Answer

A statement from the insurance company explaining what was paid, denied, or applied to deductible

Answer

An EOB explains how the insurance company processed a claim, including amounts paid, adjustments, patient responsibility, and denial reasons.

Question 2

What coding system is used to classify diagnoses in medical billing?

Accepted Answer

ICD-10-CM codes

Answer

ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) codes are used to classify and report diagnoses on medical claims.

Question 3

What is a copayment in health insurance?

Accepted Answer

A fixed dollar amount the patient pays at the time of service

Answer

A copayment (copay) is a fixed dollar amount paid by the patient at the time of service, regardless of the total cost of care.

Question 4

Which form is used to submit claims to Medicare for professional services?

Accepted Answer

CMS-1500 form

Answer

The CMS-1500 is the standard claim form used by individual providers and outpatient facilities to bill Medicare, Medicaid, and many private insurers.

Question 5

What does 'prior authorization' mean in medical billing?

Accepted Answer

Approval from the insurance company before certain services are provided

Answer

Prior authorization is pre-approval from the insurance payer confirming that a specific service, medication, or procedure will be covered before it is performed.

Specialty Certified Medical Assistant Practice Test

Specialty Certified Medical Assistant Practice Test

Specialty Certified Medical Assistant Medical Office Administration and Billing