CMA 15- insurance, billing, and coding
Exam Questions and Answers (Latest
Update 2026)
copay -
correct answer ✅an out-of-pocket fee paid by a person with health
insurance at the time a covered service, such as an office visit or a
prescription, is received
Coinsurance -
correct answer ✅is an amount a policyholder is financially
responsible for according to their insurance policies provisions. For
example, the policyholder must meet a specified deductible
amount before the medical insurance company will contribute their
portion. Typically, an 80/20 ratio allows for 80% of the allowable
charges be paid by the insurance company with the remaining 20%
to be paid by the policyholder.
Deductible -
correct answer ✅a specified amount of money that the insured
must pay before an insurance company will pay a claim
Explanation of Benefits (EOB) -
correct answer ✅is provided to the patient by the insurance
company as a statement detailing what services were paid, denied,
or reduced in payment. An EOB also includes information
,CMA 15- insurance, billing, and coding
Exam Questions and Answers (Latest
Update 2026)
pertaining to amounts applied to the deductible, coinsurance, or
allowed amounts.
remittance advice (RA) -
correct answer ✅an explanation of benefits transmitted
electronically by a payer to a provider. Contains multiple pt and
providers. Also included is the electronic fund transfer info or check
for payment. Used to post payment to patient accounts
Advanced Beneficiary Notice (ABN) -
correct answer ✅is a form a Medicare patient will sign when the
provider thinks Medicare might not pay for a specific service or
item.
patient has the option to choose to have Medicare billed, so an
official payment decision is made and a Medicare Summary Notice
sent to the patient with an explanation for noncoverage, or to not
have the charges submitted to Medicare, and receive the services
from the provider with the understanding that the patient is
responsible for payment at the time of service without the ability of
appealing to Medicare or deciding not to receive the services.
, CMA 15- insurance, billing, and coding
Exam Questions and Answers (Latest
Update 2026)
This form needs to be signed by the patient before services are
provided, with a copy to be kept on file and a copy to be given to
the patient.
federal policies -
correct answer ✅include Tricare, which covers military personnel
and their dependents. Medicaid is funded by the federal
government and managed by the state; it covers those who meet
specific eligibility criteria set by the state. Medicare is a federal
program that covers individuals age 65 and older or who need
coverage due to specific medical issues. Workers' compensation is a
state legislative law that protects employees against the cost of
medical care resulting from a work-related injury.
private policies -
correct answer ✅include group policies offered through an
individual's employer who will usually pay a portion of the premium
and deduct the remainder of the premium from the employees'
paycheck. Individual policies are insurance plans that an individual
funds themselves.
Exam Questions and Answers (Latest
Update 2026)
copay -
correct answer ✅an out-of-pocket fee paid by a person with health
insurance at the time a covered service, such as an office visit or a
prescription, is received
Coinsurance -
correct answer ✅is an amount a policyholder is financially
responsible for according to their insurance policies provisions. For
example, the policyholder must meet a specified deductible
amount before the medical insurance company will contribute their
portion. Typically, an 80/20 ratio allows for 80% of the allowable
charges be paid by the insurance company with the remaining 20%
to be paid by the policyholder.
Deductible -
correct answer ✅a specified amount of money that the insured
must pay before an insurance company will pay a claim
Explanation of Benefits (EOB) -
correct answer ✅is provided to the patient by the insurance
company as a statement detailing what services were paid, denied,
or reduced in payment. An EOB also includes information
,CMA 15- insurance, billing, and coding
Exam Questions and Answers (Latest
Update 2026)
pertaining to amounts applied to the deductible, coinsurance, or
allowed amounts.
remittance advice (RA) -
correct answer ✅an explanation of benefits transmitted
electronically by a payer to a provider. Contains multiple pt and
providers. Also included is the electronic fund transfer info or check
for payment. Used to post payment to patient accounts
Advanced Beneficiary Notice (ABN) -
correct answer ✅is a form a Medicare patient will sign when the
provider thinks Medicare might not pay for a specific service or
item.
patient has the option to choose to have Medicare billed, so an
official payment decision is made and a Medicare Summary Notice
sent to the patient with an explanation for noncoverage, or to not
have the charges submitted to Medicare, and receive the services
from the provider with the understanding that the patient is
responsible for payment at the time of service without the ability of
appealing to Medicare or deciding not to receive the services.
, CMA 15- insurance, billing, and coding
Exam Questions and Answers (Latest
Update 2026)
This form needs to be signed by the patient before services are
provided, with a copy to be kept on file and a copy to be given to
the patient.
federal policies -
correct answer ✅include Tricare, which covers military personnel
and their dependents. Medicaid is funded by the federal
government and managed by the state; it covers those who meet
specific eligibility criteria set by the state. Medicare is a federal
program that covers individuals age 65 and older or who need
coverage due to specific medical issues. Workers' compensation is a
state legislative law that protects employees against the cost of
medical care resulting from a work-related injury.
private policies -
correct answer ✅include group policies offered through an
individual's employer who will usually pay a portion of the premium
and deduct the remainder of the premium from the employees'
paycheck. Individual policies are insurance plans that an individual
funds themselves.
