NHA HOSA MEDICAL ASSISTING
EXAM STUDY GUIDE QUESTIONS
AND CORRECT SOLUTIONS||100%
GUARANTEED PASS||UPDATED
2026\2027 SYLLABUS||A+
GRADED||<<RECENT VERSION>>
Deductible - ANSWER ✓ Amount you must pay out of pocket before you begin
receiving any benefits from your insurance company
Coinsurance - ANSWER ✓ Pre established percentage of expenses paid by the
insurance company after the deductible has been met
Copayment - ANSWER ✓ A fixed dollar amount that must be paid each time a
patient visits a provider.
Coordination of Benefit rules - ANSWER ✓ Determines which insurance plan is
primary and which is secondary
Importance of verifying insurance information - ANSWER ✓ Important to make
sure that the insurances valid and the services are covered benefits
Birthday Rule - ANSWER ✓ Parent whose birthday comes 1st in the calendar
year is considered primary
Third Party Payer - ANSWER ✓ Organization other than a patient who pays for
services, such as insurance companies, Medicare, and Medicaid.
Medicare Part A - ANSWER ✓ hospitalization coverage
Medicare Part B - ANSWER ✓ Voluntary supplemental medical insurance to
help pay for physicians and other medical professionals services and medical
surgical supplies
,Medicare Part D - ANSWER ✓ Pays for medications
Medicare Advantage - ANSWER ✓ Combined package of benefits under
Medicare Parts A & B that may offer extra coverage for services such a, vision,
hearing, dental, health and wellness, or prescription coverage.
Medigap - ANSWER ✓ Private health insurance that pays for most of the charges
not covered parts A& B
Referral - ANSWER ✓ Written recommendation to a specialist
Precertification - ANSWER ✓ A review that looks at whether the procedure
could be performed safely but less expensively in an outpatient setting.
predetermination - ANSWER ✓ A written request for a verification of benefits.
Who is the gatekeeper - ANSWER ✓ primary care physician
Preauthorization - ANSWER ✓ Approval for the health plan for an inpatient
hospital stay or surgery
Tier 1 - ANSWER ✓ Providers and facilities in a PPO network
Tier 2 - ANSWER ✓ Providers and facilities within the broader, contracted
network
Tier 3 - ANSWER ✓ Providers and facilities out of the network
Tier 4 - ANSWER ✓ Providers and facilities not on the formulary
Formulary - ANSWER ✓ a list of prescription drugs covered by a specific health
care plan
Charge Description Master (CDM) - ANSWER ✓ Information about health care
services that patients have received and financial transactions that have taken
place.
, Medicare Summary Notice (MSN) - ANSWER ✓ Document that outlines the
amounts billed by the provider and what the patient must pay the provider.
Cost sharing - ANSWER ✓ The balance the policyholder must pay to the
provider.
Medical Necessity - ANSWER ✓ The documented need for a particular medical
intervention.
2 reasons a claim may be denied - ANSWER ✓ Invalid subscriber name was
given or coding error was made
V Codes - ANSWER ✓ Classify visits when circumstances, and conditions, such
as the cause of injury, poisoning, and other adverse events
E Codes - ANSWER ✓ classify external causes of environmental events,
circumstances, or conditions that caused injury, condition, or poisoning (i.e. how
an accident happened, if drug overdose was accidental or intentional)
CPT Category 1 Codes - ANSWER ✓ Primarily cover physicians services but are
used for hospital outpatient. Modifiers are used
CPT Category II Codes - ANSWER ✓ Designed to serve as supplemental
tracking codes that can be used for performance measurement. Modifiers are used
CPT Category III - ANSWER ✓ Temporary coding for new technology and
services that have not met the requirements needed
HCPS Level II - ANSWER ✓ National Codes, Uses modifiers
HCPS Level 3 Codes - ANSWER ✓ Temporary Codes
Accounts Receivable - ANSWER ✓ Patient bills for services that have already
been provided that legally are due to a facility.
Autopsy Rates - ANSWER ✓ The percent of autopsies performed on patients
who die in the hospital; reasons for not performing an autopsy in the hospital may
include legal inquiry or family preference.
, Average Length of Stay (ALOS) - ANSWER ✓ The total number of patient days
in a period divided by the number of patients; for example, the ALOS for
cardiology services in February was 6.1 days.
Benchmarks - ANSWER ✓ Goals or metrics a facility wants to meet; for
example, if the industry standard is 90% of patients should have advance directives
entered into their patient record within 24 hour of admission, and a hospital was
only meeting this for 45% of the patients, they would use the external benchmark
of 90% as a goal and track performance toward that goal by month or quarter.
Centers for Disease and Control and Prevention (CDC) - ANSWER ✓ A division
of the Department of Health and Human Services.
Chief Executive Officer (CEO) - ANSWER ✓ Leader of a facility who reports to
the Board of Directors.
Chief Financial Officer (CFO) - ANSWER ✓ Leader who oversees all financial
and fiscal decisions and issues for a facility; generally reports to the CEO.
Commercial Insurers - ANSWER ✓ Private, non-government insurers; these are
often the insurance options available through employers.
Comorbidity - ANSWER ✓ Disease that exists at the same time as a primary
disease that a patient is being treated for at the time; for example, a patient who has
cancer is receiving cancer specific treatment and is also a diabetic - diabetes
mellitus would be considered the comorbid condition.
Complications - ANSWER ✓ Unexpected events or circumstances that happen to
a patient during the course of his care; hospital-acquired infections, such as those
involving MRSA, are considered to be complications, as are reactions to
medications or an adverse response to any treatment.
Copayment - ANSWER ✓ Money the patient must pay toward the bill as
contracted between the insurer and provider; amounts range from $5 to $50, and
$75 for emergency room and specialist visits; provider's office visits are often in
the $10 to $35 range.
EXAM STUDY GUIDE QUESTIONS
AND CORRECT SOLUTIONS||100%
GUARANTEED PASS||UPDATED
2026\2027 SYLLABUS||A+
GRADED||<<RECENT VERSION>>
Deductible - ANSWER ✓ Amount you must pay out of pocket before you begin
receiving any benefits from your insurance company
Coinsurance - ANSWER ✓ Pre established percentage of expenses paid by the
insurance company after the deductible has been met
Copayment - ANSWER ✓ A fixed dollar amount that must be paid each time a
patient visits a provider.
Coordination of Benefit rules - ANSWER ✓ Determines which insurance plan is
primary and which is secondary
Importance of verifying insurance information - ANSWER ✓ Important to make
sure that the insurances valid and the services are covered benefits
Birthday Rule - ANSWER ✓ Parent whose birthday comes 1st in the calendar
year is considered primary
Third Party Payer - ANSWER ✓ Organization other than a patient who pays for
services, such as insurance companies, Medicare, and Medicaid.
Medicare Part A - ANSWER ✓ hospitalization coverage
Medicare Part B - ANSWER ✓ Voluntary supplemental medical insurance to
help pay for physicians and other medical professionals services and medical
surgical supplies
,Medicare Part D - ANSWER ✓ Pays for medications
Medicare Advantage - ANSWER ✓ Combined package of benefits under
Medicare Parts A & B that may offer extra coverage for services such a, vision,
hearing, dental, health and wellness, or prescription coverage.
Medigap - ANSWER ✓ Private health insurance that pays for most of the charges
not covered parts A& B
Referral - ANSWER ✓ Written recommendation to a specialist
Precertification - ANSWER ✓ A review that looks at whether the procedure
could be performed safely but less expensively in an outpatient setting.
predetermination - ANSWER ✓ A written request for a verification of benefits.
Who is the gatekeeper - ANSWER ✓ primary care physician
Preauthorization - ANSWER ✓ Approval for the health plan for an inpatient
hospital stay or surgery
Tier 1 - ANSWER ✓ Providers and facilities in a PPO network
Tier 2 - ANSWER ✓ Providers and facilities within the broader, contracted
network
Tier 3 - ANSWER ✓ Providers and facilities out of the network
Tier 4 - ANSWER ✓ Providers and facilities not on the formulary
Formulary - ANSWER ✓ a list of prescription drugs covered by a specific health
care plan
Charge Description Master (CDM) - ANSWER ✓ Information about health care
services that patients have received and financial transactions that have taken
place.
, Medicare Summary Notice (MSN) - ANSWER ✓ Document that outlines the
amounts billed by the provider and what the patient must pay the provider.
Cost sharing - ANSWER ✓ The balance the policyholder must pay to the
provider.
Medical Necessity - ANSWER ✓ The documented need for a particular medical
intervention.
2 reasons a claim may be denied - ANSWER ✓ Invalid subscriber name was
given or coding error was made
V Codes - ANSWER ✓ Classify visits when circumstances, and conditions, such
as the cause of injury, poisoning, and other adverse events
E Codes - ANSWER ✓ classify external causes of environmental events,
circumstances, or conditions that caused injury, condition, or poisoning (i.e. how
an accident happened, if drug overdose was accidental or intentional)
CPT Category 1 Codes - ANSWER ✓ Primarily cover physicians services but are
used for hospital outpatient. Modifiers are used
CPT Category II Codes - ANSWER ✓ Designed to serve as supplemental
tracking codes that can be used for performance measurement. Modifiers are used
CPT Category III - ANSWER ✓ Temporary coding for new technology and
services that have not met the requirements needed
HCPS Level II - ANSWER ✓ National Codes, Uses modifiers
HCPS Level 3 Codes - ANSWER ✓ Temporary Codes
Accounts Receivable - ANSWER ✓ Patient bills for services that have already
been provided that legally are due to a facility.
Autopsy Rates - ANSWER ✓ The percent of autopsies performed on patients
who die in the hospital; reasons for not performing an autopsy in the hospital may
include legal inquiry or family preference.
, Average Length of Stay (ALOS) - ANSWER ✓ The total number of patient days
in a period divided by the number of patients; for example, the ALOS for
cardiology services in February was 6.1 days.
Benchmarks - ANSWER ✓ Goals or metrics a facility wants to meet; for
example, if the industry standard is 90% of patients should have advance directives
entered into their patient record within 24 hour of admission, and a hospital was
only meeting this for 45% of the patients, they would use the external benchmark
of 90% as a goal and track performance toward that goal by month or quarter.
Centers for Disease and Control and Prevention (CDC) - ANSWER ✓ A division
of the Department of Health and Human Services.
Chief Executive Officer (CEO) - ANSWER ✓ Leader of a facility who reports to
the Board of Directors.
Chief Financial Officer (CFO) - ANSWER ✓ Leader who oversees all financial
and fiscal decisions and issues for a facility; generally reports to the CEO.
Commercial Insurers - ANSWER ✓ Private, non-government insurers; these are
often the insurance options available through employers.
Comorbidity - ANSWER ✓ Disease that exists at the same time as a primary
disease that a patient is being treated for at the time; for example, a patient who has
cancer is receiving cancer specific treatment and is also a diabetic - diabetes
mellitus would be considered the comorbid condition.
Complications - ANSWER ✓ Unexpected events or circumstances that happen to
a patient during the course of his care; hospital-acquired infections, such as those
involving MRSA, are considered to be complications, as are reactions to
medications or an adverse response to any treatment.
Copayment - ANSWER ✓ Money the patient must pay toward the bill as
contracted between the insurer and provider; amounts range from $5 to $50, and
$75 for emergency room and specialist visits; provider's office visits are often in
the $10 to $35 range.
