CMA - NHA Exam General Info Questions
& Answers
Shot Locations - ANSWERS· Intermuscular (IM) = into muscle
· Subcutaneous (subcut) = in fat
· Intradermal (ID) = underneath skin
Accountable Care Organizations (ACO) - ANSWERSgroup of physicians that work
together for coordinated/high quality care = spread it out w/ communication [Medicare
patients (65+)]
Advance beneficiary notice (ABN) - ANSWERSwhen Medicare will NOT pay for it
Capitation - ANSWERSpayment model for partial or full
Health Maintenance Organization (HMO) - ANSWERSprovide preventative and acute
care for patient BUT also require referral from PCP (primary care provider)
Preferred Provider Organization (PPO) - ANSWERScan see whoever Pt (patient) wants
to see but should consult PCP
Patient-centered Medical Home (PCMH) - ANSWERScenter for treatment and makes
sure the Pt understands their healthcare (Pt knowledge)
Pay for Performance (PFP) - ANSWERSquality measures (essence for PCP) -> return
visits for Pt
Fee For Service (FFS) - ANSWERSdo a service and get a fee SO reimburse (quantity)
Allowed amount - ANSWERSmax amount Insurance will cover
Copayment - ANSWERSpay when walk in
Deductible - ANSWERSthreshold where amount of money that is met (say 5K)
Coinsurance - ANSWERSabove deductible where the rest of the cost is SPLIT b/w
insurance and Pt (maybe 80/20)
Explanation of benefits - ANSWERSinsurance tell what is covered (breakdown)
Participating provider (PAR) - ANSWERSsplit cost b/w provider and fee of insurance to
make CHEAPER for Pt b/c In-network
, Medicare - ANSWERSelderly SO 65+ (age only) --> may also pay for additional
insurance [Federal/State]
Tricare - ANSWERSmilitary insurance (active-duty and family) civilian provider OFF-
base [Federal]
CHAMPVA - ANSWERScare for surviving spouses and dependents of deceased
veterans
Medicaid - ANSWERSgiven to people that otherwise cannot afford w/ qualify of
INCOME [Federal/State]
Workers' compensation - ANSWERSinjured on job SO company has to pay for medical
bills --> need pre-authorization (usually to a specific aware) AND might need
Drug/Alcohol test
Private insurance plans - ANSWERSo Preferred provider organization (PPO)
o Health maintenance organizations (HMOs)
Medicare Part A - ANSWERSCovers inpatient (in-bed) medical care:
· hospital expenses
· Hospice
· home health care
Medicare Part B - ANSWERSCovers outpatient medical care:
· doctor visits
· x-rays
· Bloodwork
· routine preventative care
Medicare Part C - ANSWERS· Not a program that you enroll in at Social Security.
· Instead, it is the official name for the program we now know as Medicare Advantage
· An "all in one" alternative to Original Medicare. They are offered by private companies
approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare.
· HMO, PPO, or PFFS
Medicare Part D - ANSWERS· It is an optional prescription drug program for people on
Medicare. Medicare Part D is simply insurance for your medication needs.
·You pay a monthly premium to an insurance carrier for your Part D plan. In return, you
use the insurance carrier's network of pharmacies to purchase your prescription
medications
CMS-1500 claim form - ANSWERSstandard paper claim form to bill Medicare Fee-For-
Service (FFS) Contractors when a paperclaim is allowed
& Answers
Shot Locations - ANSWERS· Intermuscular (IM) = into muscle
· Subcutaneous (subcut) = in fat
· Intradermal (ID) = underneath skin
Accountable Care Organizations (ACO) - ANSWERSgroup of physicians that work
together for coordinated/high quality care = spread it out w/ communication [Medicare
patients (65+)]
Advance beneficiary notice (ABN) - ANSWERSwhen Medicare will NOT pay for it
Capitation - ANSWERSpayment model for partial or full
Health Maintenance Organization (HMO) - ANSWERSprovide preventative and acute
care for patient BUT also require referral from PCP (primary care provider)
Preferred Provider Organization (PPO) - ANSWERScan see whoever Pt (patient) wants
to see but should consult PCP
Patient-centered Medical Home (PCMH) - ANSWERScenter for treatment and makes
sure the Pt understands their healthcare (Pt knowledge)
Pay for Performance (PFP) - ANSWERSquality measures (essence for PCP) -> return
visits for Pt
Fee For Service (FFS) - ANSWERSdo a service and get a fee SO reimburse (quantity)
Allowed amount - ANSWERSmax amount Insurance will cover
Copayment - ANSWERSpay when walk in
Deductible - ANSWERSthreshold where amount of money that is met (say 5K)
Coinsurance - ANSWERSabove deductible where the rest of the cost is SPLIT b/w
insurance and Pt (maybe 80/20)
Explanation of benefits - ANSWERSinsurance tell what is covered (breakdown)
Participating provider (PAR) - ANSWERSsplit cost b/w provider and fee of insurance to
make CHEAPER for Pt b/c In-network
, Medicare - ANSWERSelderly SO 65+ (age only) --> may also pay for additional
insurance [Federal/State]
Tricare - ANSWERSmilitary insurance (active-duty and family) civilian provider OFF-
base [Federal]
CHAMPVA - ANSWERScare for surviving spouses and dependents of deceased
veterans
Medicaid - ANSWERSgiven to people that otherwise cannot afford w/ qualify of
INCOME [Federal/State]
Workers' compensation - ANSWERSinjured on job SO company has to pay for medical
bills --> need pre-authorization (usually to a specific aware) AND might need
Drug/Alcohol test
Private insurance plans - ANSWERSo Preferred provider organization (PPO)
o Health maintenance organizations (HMOs)
Medicare Part A - ANSWERSCovers inpatient (in-bed) medical care:
· hospital expenses
· Hospice
· home health care
Medicare Part B - ANSWERSCovers outpatient medical care:
· doctor visits
· x-rays
· Bloodwork
· routine preventative care
Medicare Part C - ANSWERS· Not a program that you enroll in at Social Security.
· Instead, it is the official name for the program we now know as Medicare Advantage
· An "all in one" alternative to Original Medicare. They are offered by private companies
approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare.
· HMO, PPO, or PFFS
Medicare Part D - ANSWERS· It is an optional prescription drug program for people on
Medicare. Medicare Part D is simply insurance for your medication needs.
·You pay a monthly premium to an insurance carrier for your Part D plan. In return, you
use the insurance carrier's network of pharmacies to purchase your prescription
medications
CMS-1500 claim form - ANSWERSstandard paper claim form to bill Medicare Fee-For-
Service (FFS) Contractors when a paperclaim is allowed
