CMA (AAMA) Billing, Coding & Insurance Practice Questions
Billing, Coding & Insurance makes up 6 of every 50 questions on a Tigertest CMA (AAMA) practice test. Here are 10 of the 24 questions on it, each with the answer and the reason.
Updated by the Tigertest team. Based on the AAMA Content Outline for the CMA (AAMA) Certification Exam. Original questions; 50 per test, weighted like the real exam. Not affiliated with the AAMA.
1. A claim must report a pair of crutches supplied to a patient. Which code set is used for the crutches?
- A.ICD-10-PCS
- B.HCPCS Level II
- C.ICD-10-CM
- D.CPT Category III
Answer: B. HCPCS Level II codes cover supplies, durable medical equipment, ambulance services and some drugs. ICD-10-CM codes diagnoses.
2. What do CPT codes describe on a claim?
- A.Drugs and their doses
- B.Hospital room types
- C.Diagnoses and their symptoms
- D.Procedures and services
Answer: D. CPT codes report what the provider did, such as an office visit, an injection or a procedure. ICD-10-CM codes report why it was done.
3. What is the purpose of a modifier added to a CPT code?
- A.Show a service was altered
- B.Mark the claim as urgent
- C.Raise the payment rate
- D.Replace the diagnosis code
Answer: A. A two-character modifier tells the payer a service was changed in some way, such as performed on both sides or as a separate service, without changing the code itself.
4. A coder reports a lower-level office visit than the documentation supports. What is this called?
- A.Unbundling
- B.Balance billing
- C.Downcoding
- D.Upcoding
Answer: C. Downcoding reports a lower level of service than was provided and documented. It loses earned income and misstates the record, just as upcoding overstates it.
5. A claim lists a knee X-ray with a diagnosis code for a sore throat. Why is it likely to be denied?
- A.The patient paid a copay
- B.The X-ray was done too early
- C.Diagnosis doesn't support it
- D.The CPT code is too new
Answer: C. Medical necessity requires the diagnosis code to justify each procedure billed. Linking the right ICD-10-CM code to each CPT code prevents denials.
6. An office bills Medicare for visits that never took place. What is this?
- A.Fraud
- B.Coding error
- C.Downcoding
- D.Abuse
Answer: A. Fraud is knowingly billing for services not provided or misrepresenting them. Abuse is improper billing that may not be intentional, such as medically unnecessary services.
7. Who receives the remittance advice (RA) for a processed claim?
- A.The pharmacy
- B.The patient
- C.The employer
- D.The provider
Answer: D. The RA explains payments and adjustments to the provider. The patient gets an explanation of benefits (EOB) showing what the plan paid and what is owed.
8. A claim comes back rejected because the patient's date of birth is missing. What should the medical assistant do?
- A.Write off the balance
- B.Correct it and resubmit
- C.File an appeal
- D.Bill the patient in full
Answer: B. A rejected claim was never processed because of an error, so it is fixed and resubmitted. An appeal is for a claim that was processed and denied.
9. How does the office track claims that insurers have not paid?
- A.With a patient survey
- B.With an insurance aging report
- C.With the appointment book entries
- D.With a day sheet only
Answer: B. An insurance aging report sorts unpaid claims by how long they have been outstanding (30, 60, 90 days) so staff can follow up.
10. Which care does Medicare Part A mainly cover?
- A.Office visits
- B.Routine dental and vision care
- C.Prescription drugs
- D.Inpatient hospital stays
Answer: D. Part A covers inpatient hospital, skilled nursing facility, hospice and some home health care. Physician office visits fall under Part B.
Practice all 24 billing, coding & insurance questions, and the rest of the 200-question bank, in the free CMA (AAMA) training sets. Questions you miss come back until you have mastered them.
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