National Healthcareer Association
2 NIMDA · AMCC
NHA
NHA Certified Clinical Medical Assistant (CCMA)
★ ★
EST. 1989
EMPOWERING PEOPLE TO ACCESS BETTER CARE
NHA CCMA — Administrative Assisting Review Part 2
B I L L I N G , CO D I N G , I N S U RA N C E , E M R , O F F I C E M A N AG E M E N T & CO M P L I A N C E
INSTITUTION National Healthcareer Association PROGRAM Certified Clinical Medical Assistant
(NHA) (CCMA)
DOMAIN Administrative Assisting — ACADEMIC YEAR
Advanced Topics
STUDY GUIDE Complete Administrative Review TOTAL QUESTIONS 101 Questions
With Verified Answers
CONTENT AREAS Billing, Coding, EMR, Office FORMAT Multiple Choice — Select the
Mgmt, Compliance, Insurance Single Best Answer
STUDY GUIDE INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Topics: ICD-10/CPT coding, billing procedures, insurance claims, referrals, EMR/EHR systems, office
management, compliance, HIPAA.
▸ All content aligns with the NHA CCMA certification examination blueprint — Administrative Assisting
domain.
▸ Correct answers and detailed rationales appear below each question.
SECTION I — BILLING, CODING, INSURANCE, EMR &
Questions 1 – 101
OFFICE MANAGEMENT
,1. When assigning ICD-10-CM diagnosis codes, to what level should the medical assistant
code?
A. To the third character only
B. To the highest level of specificity available
C. To the first three characters only
D. Any level is acceptable for reimbursement
CORRECT ANSWER B — To the highest level of specificity available
RATIONALE ICD-10-CM codes must be coded to the highest level of specificity (the maximum
number of characters available for that code). Coding to the highest specificity
helps avoid denial of reimbursement and ensures accurate documentation of the
patient's condition. Unspecified codes should only be used when the medical
record does not provide sufficient detail.
2. What is direct billing?
A. The patient pays the provider directly and files their own claim
B. The insurance carrier allows a provider to submit insurance claims directly to the carrier
electronically
C. A third-party billing service submits claims on behalf of the provider
D. Claims are mailed via paper to the insurance carrier
CORRECT ANSWER B — The insurance carrier allows a provider to submit insurance claims
directly to the carrier electronically
RATIONALE Direct billing is the process by which an insurance carrier allows a provider to
submit insurance claims directly to the carrier electronically, without going
through a clearinghouse. This is the fastest method of claims submission.
Clearinghouse submission batches multiple claims for various carriers. Paper
claims are the slowest method.
,3. What is a clearinghouse submission in medical billing?
A. The provider bills the patient directly
B. A service that allows a provider to submit multiple insurance claims electronically in
batches, using software to audit and sort claims for various carriers
C. The insurance company processes claims internally
D. A manual paper-based claims submission process
CORRECT ANSWER B — A service that allows a provider to submit multiple insurance claims
electronically in batches, using software to audit and sort claims for various
carriers
RATIONALE A clearinghouse acts as an intermediary between providers and insurance
carriers. It allows providers to submit multiple claims electronically in batches for
a small fee. The clearinghouse software audits claims for errors, sorts them by
insurance carrier, and forwards them appropriately. This is more efficient than
submitting claims individually to each carrier.
4. What is the universal claim form used for government-sponsored claims?
A. UB-04 form
B. CMS-1500 form
C. HCFA-1450 form
D. CMS-1490 form
CORRECT ANSWER B — CMS-1500 form
RATIONALE The CMS-1500 form (formerly HCFA-1500) is the universal claim form used to
submit all government-sponsored claims (Medicare, Medicaid, TRICARE) and
most private insurance claims for outpatient services. The UB-04 (CMS-1450) is
used for hospital/facility inpatient and outpatient claims. The CMS-1500 contains
procedural coding related to patient care.
, 5. What is the primary goal of chart reviews conducted by insurance companies?
A. To increase provider reimbursement
B. To reduce payment errors by ensuring services meet coverage and medical necessity
requirements
C. To train medical assistants on documentation
D. To market insurance plans to providers
CORRECT ANSWER B — To reduce payment errors by ensuring services meet coverage and
medical necessity requirements
RATIONALE Chart reviews (medical record audits) are conducted by insurance companies to
ensure payment is made only for services that meet plan coverage and medical
necessity requirements. The goal is to reduce payment errors by identifying and
addressing documentation issues, billing errors, and diagnosis coding
inaccuracies. Reviews may be conducted pre-payment or post-payment.
6. What three factors determine the level of service in Evaluation and Management (E/M)
coding?
A. Diagnosis, procedure, and follow-up
B. History, examination, and medical decision-making
C. Chief complaint, vital signs, and assessment
D. Patient age, insurance type, and time spent
CORRECT ANSWER B — History, examination, and medical decision-making
RATIONALE E/M codes are determined by three key components: History (chief complaint,
HPI, ROS, PFSH), Examination (problem-focused to comprehensive), and Medical
Decision-Making (straightforward to high complexity). The level of each
component determines the overall E/M code level. Time can also be a factor when
counseling/coordination of care dominates the visit.
2 NIMDA · AMCC
NHA
NHA Certified Clinical Medical Assistant (CCMA)
★ ★
EST. 1989
EMPOWERING PEOPLE TO ACCESS BETTER CARE
NHA CCMA — Administrative Assisting Review Part 2
B I L L I N G , CO D I N G , I N S U RA N C E , E M R , O F F I C E M A N AG E M E N T & CO M P L I A N C E
INSTITUTION National Healthcareer Association PROGRAM Certified Clinical Medical Assistant
(NHA) (CCMA)
DOMAIN Administrative Assisting — ACADEMIC YEAR
Advanced Topics
STUDY GUIDE Complete Administrative Review TOTAL QUESTIONS 101 Questions
With Verified Answers
CONTENT AREAS Billing, Coding, EMR, Office FORMAT Multiple Choice — Select the
Mgmt, Compliance, Insurance Single Best Answer
STUDY GUIDE INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Topics: ICD-10/CPT coding, billing procedures, insurance claims, referrals, EMR/EHR systems, office
management, compliance, HIPAA.
▸ All content aligns with the NHA CCMA certification examination blueprint — Administrative Assisting
domain.
▸ Correct answers and detailed rationales appear below each question.
SECTION I — BILLING, CODING, INSURANCE, EMR &
Questions 1 – 101
OFFICE MANAGEMENT
,1. When assigning ICD-10-CM diagnosis codes, to what level should the medical assistant
code?
A. To the third character only
B. To the highest level of specificity available
C. To the first three characters only
D. Any level is acceptable for reimbursement
CORRECT ANSWER B — To the highest level of specificity available
RATIONALE ICD-10-CM codes must be coded to the highest level of specificity (the maximum
number of characters available for that code). Coding to the highest specificity
helps avoid denial of reimbursement and ensures accurate documentation of the
patient's condition. Unspecified codes should only be used when the medical
record does not provide sufficient detail.
2. What is direct billing?
A. The patient pays the provider directly and files their own claim
B. The insurance carrier allows a provider to submit insurance claims directly to the carrier
electronically
C. A third-party billing service submits claims on behalf of the provider
D. Claims are mailed via paper to the insurance carrier
CORRECT ANSWER B — The insurance carrier allows a provider to submit insurance claims
directly to the carrier electronically
RATIONALE Direct billing is the process by which an insurance carrier allows a provider to
submit insurance claims directly to the carrier electronically, without going
through a clearinghouse. This is the fastest method of claims submission.
Clearinghouse submission batches multiple claims for various carriers. Paper
claims are the slowest method.
,3. What is a clearinghouse submission in medical billing?
A. The provider bills the patient directly
B. A service that allows a provider to submit multiple insurance claims electronically in
batches, using software to audit and sort claims for various carriers
C. The insurance company processes claims internally
D. A manual paper-based claims submission process
CORRECT ANSWER B — A service that allows a provider to submit multiple insurance claims
electronically in batches, using software to audit and sort claims for various
carriers
RATIONALE A clearinghouse acts as an intermediary between providers and insurance
carriers. It allows providers to submit multiple claims electronically in batches for
a small fee. The clearinghouse software audits claims for errors, sorts them by
insurance carrier, and forwards them appropriately. This is more efficient than
submitting claims individually to each carrier.
4. What is the universal claim form used for government-sponsored claims?
A. UB-04 form
B. CMS-1500 form
C. HCFA-1450 form
D. CMS-1490 form
CORRECT ANSWER B — CMS-1500 form
RATIONALE The CMS-1500 form (formerly HCFA-1500) is the universal claim form used to
submit all government-sponsored claims (Medicare, Medicaid, TRICARE) and
most private insurance claims for outpatient services. The UB-04 (CMS-1450) is
used for hospital/facility inpatient and outpatient claims. The CMS-1500 contains
procedural coding related to patient care.
, 5. What is the primary goal of chart reviews conducted by insurance companies?
A. To increase provider reimbursement
B. To reduce payment errors by ensuring services meet coverage and medical necessity
requirements
C. To train medical assistants on documentation
D. To market insurance plans to providers
CORRECT ANSWER B — To reduce payment errors by ensuring services meet coverage and
medical necessity requirements
RATIONALE Chart reviews (medical record audits) are conducted by insurance companies to
ensure payment is made only for services that meet plan coverage and medical
necessity requirements. The goal is to reduce payment errors by identifying and
addressing documentation issues, billing errors, and diagnosis coding
inaccuracies. Reviews may be conducted pre-payment or post-payment.
6. What three factors determine the level of service in Evaluation and Management (E/M)
coding?
A. Diagnosis, procedure, and follow-up
B. History, examination, and medical decision-making
C. Chief complaint, vital signs, and assessment
D. Patient age, insurance type, and time spent
CORRECT ANSWER B — History, examination, and medical decision-making
RATIONALE E/M codes are determined by three key components: History (chief complaint,
HPI, ROS, PFSH), Examination (problem-focused to comprehensive), and Medical
Decision-Making (straightforward to high complexity). The level of each
component determines the overall E/M code level. Time can also be a factor when
counseling/coordination of care dominates the visit.
