NHA CCMA Exam 2025 M o s t R e c e n t E x a m A c t u a l
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Advance Beneficiary Notice (ABN)
A form provided to the patient when the provider believes Medicare will
probably not pay for services received
Allowed Amount
The maximum amount a third-party payer will pay for a particular procedure or
service
Copayment
a small fixed fee paid by the patient at the time of an office visit
Coinsurance
a provision under which both the insured and the insurer share the covered
losses, typically 80:20
deductible
specific amount of money a patient must pay out of pocket before the insurance
carrier begins paying
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Explanation of Benefits
a form created by the insurance company to explain what charges were
covered, denied, or need more documentation based on the claims submitted
by the physician's office
Participating provider (PAR)
Providers who agree to write off the difference between the amount charged by
the provider and the approved fee established by the insurer
Medicare
A federal program of health insurance for persons 65 years of age and older by
Part A (hospitalization) or Part B (routine medical office visits)
Tricare
U.S. government health insurance plan for all military personnel
CHAMPVA
covers surviving spouses and dependent children of veterans who died as a
result of service-related disabilities
Medicaid
provides health insurance to the medically indigent population through a cost-
sharing program between federal and state governments for those who meet
specific eligibility criteria
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Managed Care
is an umbrella term for plans that provide health care in return for preset
scheduled payments and coordinated care through a defined network of
providers and hospitals
CMS-1500 form
Standard insurance form used by all government and most commercial
insurance payers.
- 33 blocks
- divided into three section
CMS-1500 Section 1
Carrier Block: contains the address of the insurance carrier and is located at
the top of the form
CMS-1500 Section 2
Patient/insured section: contains information about the patient or insured;
includes boxes 1-13
CMS-1500 Section 3
Physician/Supplier Section: contains information about the physician or
supplier: boxes 14-33
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Left Hypochondriac Region
left upper region below the rib cartilage
Right lumbar Region
right middle region near the waist
Left Lumbar Region
Right Iliac Region
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