CMAA NHA Certified Medical Administrative Assistant - Set 5 - Part 2

Correct Answer: CMS-1500 form

The CMS-1500 form is used for professional services such as physicians, NPs, PAs, and therapists, with the electronic equivalent being the eight-three-seven-P transaction submitted through clearinghouses to payers. Option a is incorrect because the UB-04 form is used for institutional claims such as hospitals, SNFs, home health, and hospice, with the electronic equivalent being the eight-three-seven-I transaction rather than the professional form. Option b is incorrect because Form W-2 reports wages and tax for employees, which is a tax form rather than a health care claim form used for professional services in the revenue cycle at the practice. Option d is incorrect because Form I-9 verifies employment eligibility, which is an employment form rather than a health care claim form used for professional services in the revenue cycle at the practice today.

Correct Answer: Place of service ten

Place of service ten captures telehealth provided in the patient's home, while place of service two covers telehealth not in the patient's home, with codes eleven, twenty-one, and twenty-three covering office, inpatient, and emergency settings. Option a is incorrect because place of service eleven covers office visits rather than telehealth, so it does not match the telehealth-in-home scenario described in this kind of claim entry for the visit today. Option b is incorrect because place of service twenty-one covers inpatient hospital encounters rather than telehealth, so it does not match the telehealth-in-home scenario described in this kind of claim entry today. Option c is incorrect because place of service twenty-three covers emergency department visits rather than telehealth, so it does not match the telehealth-in-home scenario described in this kind of claim entry today.

Correct Answer: Identify the provider on claims

The National Provider Identifier is a ten-digit identifier that identifies the provider on claims, with Type One for individuals and Type Two for organizations, supporting accurate routing and adjudication across the claim submission process. Option a is incorrect because the NPI does not capture patient demographic data, which is collected separately at registration and entered into the demographic fields of the claim rather than into the provider identifier. Option c is incorrect because the NPI does not track inventory of supplies, which is a different operational function handled through inventory management tools rather than the claim's provider identifier field at the practice. Option d is incorrect because the NPI does not replace the diagnosis code, which is captured through ICD-10-CM and remains the diagnosis source on the claim alongside the provider's NPI for the encounter being billed today.

Correct Answer: Medicare twelve months; others vary

Medicare's timely filing limit is twelve months from the date of service, while Medicaid is state-specific and commercial payers range from ninety days to a year, with late claims denied for timely filing. Option b is incorrect because thirty days is shorter than the actual timely-filing limits used by Medicare, Medicaid, and commercial payers, which range from ninety days to a year depending on the payer and contract terms. Option c is incorrect because ten years is far longer than any standard timely-filing limit used by Medicare or commercial payers, and would not match the actual filing windows used in current health care billing practice. Option d is incorrect because timely filing rules do exist for every payer; ignoring them risks denials and unrecoverable revenue, which is exactly why the practice tracks submission dates against payer-specific filing limits.

Correct Answer: Total time or medical decision-making

Office and outpatient codes are selected by total time on the date of encounter or by medical decision-making complexity following the major 2021 office and other outpatient code update. Option a is incorrect because patient zip code is unrelated to E/M code selection and is not part of the documented method for choosing the level of office and other outpatient codes under the current rules. Option b is incorrect because the number of words spoken aloud is unrelated to E/M code selection and is not part of the documented method for choosing office and other outpatient code levels under current rules. Option d is incorrect because humidity in the room is unrelated to E/M code selection and is not part of the documented method for choosing the level of office and other outpatient codes under current coding rules.

Correct Answer: Track outstanding receivables by age

Aging buckets track outstanding receivables by age, separately for insurance and patient receivables, so the practice can investigate aging accounts, work denials, and pursue patient balances before they become uncollectible over time. Option a is incorrect because lunch preferences are unrelated to receivables aging, which focuses on the time accounts have been outstanding rather than employee meal-break tastes during the work week at the practice. Option b is incorrect because parking lot turnover is unrelated to receivables aging, which focuses on outstanding accounts rather than the physical turnover of vehicles in the practice's parking facility during the day. Option c is incorrect because new staff onboarding times are unrelated to receivables aging, which focuses on outstanding accounts rather than the duration of employee orientation at the practice during the year.

Correct Answer: Contractual adjustment

Contractual adjustments are the routine difference between billed charges and the contracted allowed amount for in-network claims, automatically applied when claims process and reflected in the aging and reconciliation reports for the practice today. Option b is incorrect because bad debt write-offs apply when collection efforts have failed rather than to the routine difference between billed charges and the allowed amount under an in-network contract for the visit being adjudicated. Option c is incorrect because charity care write-offs apply when the patient cannot pay through a means-tested financial assistance application rather than to the routine in-network billed-versus-allowed difference being recorded in this scenario. Option d is incorrect because hardship adjustments are tied to specific patient circumstances and documented financial assistance rather than to the routine in-network billed-versus-allowed difference being recorded for this claim today.

Correct Answer: Fair Debt Collection Practices Act

The Fair Debt Collection Practices Act governs the conduct of debt collectors when contacting consumers about a debt, with required notice to the patient before placement and stop-collection rules when disputes are raised. Option a is incorrect because the Bloodborne Pathogens Standard covers workplace exposure to infectious materials rather than debt collector conduct, so it does not match the conduct framework that applies to external collection agency activity. Option b is incorrect because Joint Commission survey rules cover accreditation standards rather than debt collector conduct, so they do not match the conduct framework that applies to external collection agency activity for the patient. Option d is incorrect because the ICD-10-CM coding manual is a coding reference rather than a debt collection conduct framework, so it does not match the federal law that governs the agency's contact with consumers.

Correct Answer: Identify within sixty days; refund and document

Practices must identify overpayments within sixty days under CMS rules and refund per applicable law, with documentation supporting the action and reconciliation of patient and payer accounts in the system. Option a is incorrect because waiting two years without records conflicts with the sixty-day identification timeline and the documentation expectations, exposing the practice to compliance risk and creating reconciliation gaps in the system. Option c is incorrect because keeping the overpayment indefinitely is improper under federal rules, since CMS expects identification within sixty days and refund per applicable law, with documentation kept in the practice's records. Option d is incorrect because sending the overpayment to a friend's account would constitute fraud and would conflict with both the refund expectation and the practice's basic financial controls in the cycle at the practice.

Correct Answer: Small balance write-off

Small balance write-offs remove balances that fall under a defined dollar threshold, often around ten dollars, since pursuing them costs more in staff time and statements than the balance itself would recover. Option a is incorrect because charity care write-offs apply when the patient qualifies through a means-tested financial assistance application, which is a different category than a low-value cleanup adjustment under a dollar threshold. Option b is incorrect because bad debt write-offs apply when collection efforts have failed rather than to a low-value cleanup adjustment under a dollar threshold, which is a different category in the practice's accounting structure. Option c is incorrect because statute of limitations write-offs apply when the time limit for filing or collection has passed, which is a different category from a low-value cleanup adjustment under a dollar threshold today.

Correct Answer: Translate; validate; route claims to payers

Clearinghouses translate HIPAA transactions, validate and scrub claims, route claims to payers, manage acknowledgments such as nine-nine-nine and two-seven-seven-CA, and handle ERA and eligibility transactions across many payer connections. Option b is incorrect because clearinghouses do not diagnose, treat, or prescribe; they are administrative intermediaries that route and validate claims rather than clinical providers serving patients in the practice today. Option c is incorrect because clearinghouses do not schedule, counsel, or cook; they are administrative intermediaries that route and validate claims rather than clinical or operational service providers at the practice today. Option d is incorrect because clearinghouses do not mop, wax, or polish floors; they are administrative intermediaries that route and validate claims rather than facility maintenance providers at the practice during the work day.

Correct Answer: Claim number; adjuster; itemized bill

Workers' compensation billing requires the claim number from the employer or carrier, an adjuster contact, often itemized bills, and may involve independent medical examination reports per the state's workers' compensation rules. Option a is incorrect because marketing items are unrelated to workers' compensation billing, which focuses on the claim number, adjuster contact, and required documentation rather than promotional content for the practice or the carrier. Option b is incorrect because birthdays and anniversaries are unrelated to workers' compensation billing, which focuses on the claim number, adjuster contact, and required documentation rather than personal lifestyle facts about the patient or staff. Option d is incorrect because pet names and vacation plans are unrelated to workers' compensation billing, which focuses on the claim number, adjuster contact, and required documentation rather than personal lifestyle facts at the practice.

Correct Answer: Professional versus institutional claims transmission

The eight-three-seven-P transaction transmits professional claims such as physician services, while eight-three-seven-I transmits institutional claims for hospitals, with eight-three-seven-D used for dental services in the family. Option a is incorrect because the contrast is professional versus institutional claims rather than inpatient versus outpatient diagnoses, which is a different distinction tracked through codes and coverage rather than the claim transaction format itself. Option b is incorrect because the contrast is professional versus institutional claims rather than pediatric versus adult treatments, which is unrelated to the claim transaction format and is tracked through other parts of the claim submission. Option c is incorrect because the contrast is professional versus institutional claims rather than telehealth versus in-person modalities, which is captured through modifiers and place-of-service codes rather than the underlying claim transaction format itself.

Correct Answer: Missing referral; expired auth; wrong CPT

Common authorization-related pitfalls include missing referrals, expired authorizations, the wrong CPT code on the auth, insufficient units approved, and services performed before authorization is on file with the practice's billing team. Option a is incorrect because calm tone, clean uniform, and punctuality describe professional presence rather than authorization workflow pitfalls, so they do not match the post-mortem topic the team is reviewing today during this discussion. Option c is incorrect because snacks, pet photos, and jokes are unrelated to authorization workflow pitfalls and are not part of the documented post-mortem topics the team is reviewing during the discussion at the practice today. Option d is incorrect because music, flowers, and candles are unrelated to authorization workflow pitfalls and are not part of the documented post-mortem topics the team is reviewing during the discussion at the practice today.

Correct Answer: Prevent improper unbundling

National Correct Coding Initiative edits prevent improper unbundling by identifying code pairs that should not be billed together, supporting compliance with federal coding rules and reducing fraud risk under the False Claims Act. Option b is incorrect because NCCI edits do not promote marketing campaigns; they are coding rules rather than promotional tools, so they do not match the marketing concept the option suggests during the claim scrubbing workflow. Option c is incorrect because NCCI edits do not track parking minutes; they are coding rules rather than parking management tools, so they do not match the parking concept the option suggests during the claim scrubbing workflow. Option d is incorrect because NCCI edits do not replace ICD-10 entirely, which remains the diagnosis code set used across health care, while NCCI focuses on procedure code pairs rather than diagnosis system replacement at all.

Correct Answer: Terminal digit filing

Terminal digit filing breaks the MRN into pairs read right to left, with primary by the rightmost pair, then secondary, then tertiary, reducing filing congestion and misfile rate compared to straight numeric filing. Option a is incorrect because pure alphabetical filing files by patient last name rather than by reversed numeric segments, which is a different approach than the terminal digit method described in this scenario at the practice. Option b is incorrect because subject filing organizes non-patient records by topic, which is a different approach than the patient record filing method described in this scenario at the practice during a filing review today. Option c is incorrect because geographic filing organizes records by location for multi-site organizations, which is a different approach than the patient record filing method described in this scenario at the practice today.

Correct Answer: Receipts plus cash equal set fund

The imprest method maintains a set fund amount, with receipts taken for every disbursement so receipts plus remaining cash always equal the fund total, replenished by a check for the total of receipts. Option a is incorrect because spending cash without records would defeat the imprest method, since the system depends on receipts plus remaining cash equaling the set fund total at every reconciliation point during the period. Option b is incorrect because replenishing only at year end would undermine the imprest method, since the standard cadence is periodic replenishment by a check for the total of receipts whenever the fund needs refreshing. Option d is incorrect because the imprest method does not eliminate cash management; it structures it through a set fund and disciplined receipts tracking that supports reconciliation and accountability at the practice today.

Correct Answer: Prepare site for safe smooth start

Opening procedures prepare the site for a safe, smooth start, including alarm disable, unlocking, lighting, system boot, EHR login, schedule printing, message review, stocking the waiting room, and verifying refrigerator and AED readiness. Option a is incorrect because waiting passively for staff arrival fails the opening checklist, since the site needs to be prepared before patients arrive and before clinical staff begin rooming the first appointments at the practice. Option c is incorrect because sending patients away today defeats the purpose of opening, which is to prepare the site for the day's appointments rather than to redirect or discharge waiting patients from the practice. Option d is incorrect because replacing the practice manager is unrelated to opening procedures, which focus on site readiness rather than personnel structure changes at the practice during the start of the work day.

Correct Answer: Surface misfiles visually for quick correction

Color coding makes misfiles visible at a glance because mismatched colors flash in a row of charts, supporting fast correction during routine audits and reducing the time and risk of working with misfiled records. Option b is incorrect because color coding does not replace patient identifiers; the chart still uses identifiers such as name and MRN, while color coding adds a visual aid for finding misfiles during routine audits today. Option c is incorrect because color coding does not encrypt records, which is a technical safeguard for electronic data rather than a paper-filing visual aid used to surface misfiles during routine audits at the practice. Option d is incorrect because color coding does not block access to records; it makes misfiles visible during routine audits rather than restricting role-based access to the chart contents at the practice during a regular workflow.

Correct Answer: Secure site and complete daily reconciliation

Closing procedures secure the site and complete daily reconciliation, including confirming no patients remain, reconciling cash, securing records, checking refrigerator logs, setting thermostats, locking, and activating the alarm before the staff leaves. Option a is incorrect because opening the office for night appointments contradicts a closing checklist, which prepares the site for the end of the work day rather than for additional appointments during the night at the practice. Option b is incorrect because replacing front-desk staff overnight is unrelated to closing procedures, which focus on site security and reconciliation rather than personnel changes at the practice during the closing routine itself. Option d is incorrect because a marketing event in the lobby is unrelated to closing procedures, which focus on site security and reconciliation rather than promotional events at the practice during the end of the work day.