1|Page
Module 5 CMAA Questions and Answers with
Solutions UPDATED!!!
Demographics - ANSWER Characteristics of a patient such as
name, address, date of birth, contact and insurance information
necessary for filing a claim.
Elibility - ANSWER Meeting the stipulated requirements to
participate in the health care plan.
How can the CMAA make a positive impression on patients and
support the patient relationship with the provider and the
health care organization? - ANSWER Welcome the patient and
demonstrate a professional manner and a genuine disposition.
Be an active listener and communicate effectively. Be aware of
the diversity of the patient's needs and apply considerations or
accommodations when needed. If the CMAA is uncertain how
best to communicate with or accommodate a patient, ask them.
Before the patient arrives for the scheduled appointment, the
CMAA should know - ANSWER the CMAA should know what
type of insurance coverage the patient has, if the provider is a
participating provider (in-network) in that plan, and whether
,2|Page
the health care organization provides the services the patient
needs. The patient's experience with the health care
organization and the vested members is of utmost importance
to ensure patients are satisfied.
Demographic information includes - ANSWER contact
information as well as insurance information. Every visit must
follow this process, even if the patient was seen in the same
setting the day before. Remember, information entered in the
patient's demographics is later used to create insurance claims;
therefore, efficiency and accuracy will directly impact the
revenue cycle.
In Network - ANSWER An insurance plan in which a provider
signs a contract to participate. The provider agrees to accept a
discounted rate for procedures.
Primary Insurance - ANSWER The insurance plan responsible for
paying health care insurance claims.
Secondary Insurance - ANSWER The insurance plan that is billed
after the primary insurance plan has paid its contracted
amount.
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Tertiary Insurance - ANSWER Insurance coverage in addition to
primary and secondary insurance. Tertiary insurance covers
gaps in primary and secondary insurance coverage.
Coordination of Benefits COB - ANSWER A provision in group
health insurance that prevents multiple insurers from paying
benefits covered by other policies; also specifies that coverage
will be provided in a specific sequence when more than one
policy covers the claim.
Coinsurance - ANSWER The percentage of the allowed amount
the patient will pay once the deductible is met.
Copayment - ANSWER A set amount determined by the
plan/payer that the patient pays for specified services, usually
office visits and emergency department visits.
Deductible - ANSWER The amount that must be paid before
benefits are paid by the insurance.
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nce the patient arrives for the scheduled appointment, the
CMAA will need to - ANSWER scan or copy the insurance cards.
It is also important to verify patient identity with photo
identification, such as a state-issued driver's license or state-
issued identification. Completing patient verification, reviewing
and updating patient information, and completing any
necessary compliance forms are essential to the patient check-
in process each time the patient has a visit.
Remember that patients who have not been seen by the
provider (or a provider of the same specialty within the group)
for three years are considered new patients. T or F - ANSWER T
When performing patient check-in tasks, the CMAA should
always do the following. - ANSWER Obtain demographic
information when scheduling visits.
Ask patients if there are any changes in their primary insurance,
and check for any secondary insurance or tertiary insurance
coverage.
Determine the coordination of benefits (COB). The COB
addresses the order of insurance coverage of claims when a
patient has more than one third-party payer. It determines
which insurance is billed first, then second, and so on.
Module 5 CMAA Questions and Answers with
Solutions UPDATED!!!
Demographics - ANSWER Characteristics of a patient such as
name, address, date of birth, contact and insurance information
necessary for filing a claim.
Elibility - ANSWER Meeting the stipulated requirements to
participate in the health care plan.
How can the CMAA make a positive impression on patients and
support the patient relationship with the provider and the
health care organization? - ANSWER Welcome the patient and
demonstrate a professional manner and a genuine disposition.
Be an active listener and communicate effectively. Be aware of
the diversity of the patient's needs and apply considerations or
accommodations when needed. If the CMAA is uncertain how
best to communicate with or accommodate a patient, ask them.
Before the patient arrives for the scheduled appointment, the
CMAA should know - ANSWER the CMAA should know what
type of insurance coverage the patient has, if the provider is a
participating provider (in-network) in that plan, and whether
,2|Page
the health care organization provides the services the patient
needs. The patient's experience with the health care
organization and the vested members is of utmost importance
to ensure patients are satisfied.
Demographic information includes - ANSWER contact
information as well as insurance information. Every visit must
follow this process, even if the patient was seen in the same
setting the day before. Remember, information entered in the
patient's demographics is later used to create insurance claims;
therefore, efficiency and accuracy will directly impact the
revenue cycle.
In Network - ANSWER An insurance plan in which a provider
signs a contract to participate. The provider agrees to accept a
discounted rate for procedures.
Primary Insurance - ANSWER The insurance plan responsible for
paying health care insurance claims.
Secondary Insurance - ANSWER The insurance plan that is billed
after the primary insurance plan has paid its contracted
amount.
,3|Page
Tertiary Insurance - ANSWER Insurance coverage in addition to
primary and secondary insurance. Tertiary insurance covers
gaps in primary and secondary insurance coverage.
Coordination of Benefits COB - ANSWER A provision in group
health insurance that prevents multiple insurers from paying
benefits covered by other policies; also specifies that coverage
will be provided in a specific sequence when more than one
policy covers the claim.
Coinsurance - ANSWER The percentage of the allowed amount
the patient will pay once the deductible is met.
Copayment - ANSWER A set amount determined by the
plan/payer that the patient pays for specified services, usually
office visits and emergency department visits.
Deductible - ANSWER The amount that must be paid before
benefits are paid by the insurance.
, 4|Page
nce the patient arrives for the scheduled appointment, the
CMAA will need to - ANSWER scan or copy the insurance cards.
It is also important to verify patient identity with photo
identification, such as a state-issued driver's license or state-
issued identification. Completing patient verification, reviewing
and updating patient information, and completing any
necessary compliance forms are essential to the patient check-
in process each time the patient has a visit.
Remember that patients who have not been seen by the
provider (or a provider of the same specialty within the group)
for three years are considered new patients. T or F - ANSWER T
When performing patient check-in tasks, the CMAA should
always do the following. - ANSWER Obtain demographic
information when scheduling visits.
Ask patients if there are any changes in their primary insurance,
and check for any secondary insurance or tertiary insurance
coverage.
Determine the coordination of benefits (COB). The COB
addresses the order of insurance coverage of claims when a
patient has more than one third-party payer. It determines
which insurance is billed first, then second, and so on.
