Administrative assisting is 12 of the 150 scored items on the NHA CCMA. Answer 10 exam style questions on health insurance basics and see exactly which concepts would cost you points on test day.
Start the 10 questions →In insurance terms, who is the 'subscriber' (policyholder)?
These questions cover insurance terms, participating providers, managed care, government programs and eligibility. Each one shows the correct answer and why every other option is wrong, so a miss tells you exactly what to review before the CCMA.
Prefer to read first? Every question from the practice set above, with the correct answer and why each wrong option is wrong.
Answer: C. The subscriber (policyholder or insured) holds the policy, often through an employer. Dependents, such as a spouse or children, are covered under the subscriber's policy.
Why not A: The claims examiner works for the insurer.
Why not B: The provider bills but is not the subscriber.
Why not D: Patients may be dependents rather than the subscriber.
Exam tactic: Subscriber = policyholder. Dependents ride along.
Answer: C. Participating (in-network) providers agree to accept the plan's allowed amount. The difference between the charge and the allowed amount is adjusted off; billing the patient for it (balance billing) is not permitted under the contract.
Why not A: Secondary insurance pays based on its own rules, not automatically for write-offs.
Why not B: Balance billing the patient violates the participation agreement.
Why not D: Deductibles are not adjusted this way.
Exam tactic: In-network: accept the allowed amount, write off the rest.
Answer: A. HMOs usually require a primary care provider who coordinates care and provides referrals, and they cover little or nothing out of network except emergencies. PPOs allow specialist visits without referrals and offer some out-of-network coverage at higher cost.
Why not B: PPOs generally do not require referrals.
Why not C: An HSA is a savings account paired with a high-deductible plan, not a plan type that manages referrals.
Why not D: Traditional indemnity plans allow any provider.
Exam tactic: HMO: PCP gatekeeper + referrals.
Answer: A. TRICARE is the health program of the Military Health System. CHAMPVA covers certain dependents and survivors of veterans who are not eligible for TRICARE.
Why not B: Medicaid is based on income and other criteria.
Why not C: CHAMPVA covers certain veterans' dependents and survivors.
Why not D: Workers' compensation covers work-related injuries.
Exam tactic: TRICARE = military families.
Answer: C. Plans change, coverage can end, and benefits vary. Verifying eligibility and benefits (and any referral or authorization requirements) before the visit prevents denials and surprises for the patient.
Why not A: Verification does not eliminate copays.
Why not B: Self-pay patients do not have coverage to verify.
Why not D: Established patients' coverage can change too.
Exam tactic: Verify every time: coverage changes.
Answer: A. Insurance cards list the member (subscriber) ID, group number, plan type, copay information, and claims and customer service contacts. The office copies both sides.
Why not B: Lab results are not on insurance cards.
Why not C: Medical history is not on insurance cards.
Why not D: Diagnosis codes are on claims, not cards.
Exam tactic: Copy both sides of the card.
Answer: C. Self-pay and uninsured patients should receive a good-faith estimate of expected charges before scheduled care, consistent with office policy and federal requirements such as the No Surprises Act. Payment options can be discussed.
Why not A: Withholding cost information is poor practice and may violate requirements.
Why not B: Care is not free unless a program provides it.
Why not D: Inflated estimates mislead the patient.
Exam tactic: Uninsured? Good-faith estimate up front.
Answer: A. Medicaid is a joint federal-state program for eligible low-income individuals and certain groups. Each state administers its own program within federal guidelines, so eligibility and benefits vary. Eligibility is often verified at every visit.
Why not B: Medicare Part A is hospital insurance for Medicare beneficiaries.
Why not C: Medicaid is a government program, not an employer plan.
Why not D: Medicaid is not limited by age; Medicare is the program for 65 and older.
Exam tactic: Medicaid = federal + state, varies by state.
Answer: C. Under the birthday rule, the plan of the parent whose birth month and day fall earlier in the calendar year is primary for dependent children; the year of birth does not matter. Different rules can apply for divorced or separated parents or court orders.
Why not A: The gender rule is outdated and not the standard.
Why not B: Premium cost does not determine primacy.
Why not D: The parent's age (birth year) is not the deciding factor.
Exam tactic: Birthday rule: earliest month/day wins; ignore the year.
Answer: B. An ABN informs the Medicare beneficiary before the service that Medicare may not pay, gives an estimated cost, and lets the patient choose whether to receive it and accept financial responsibility. It must be given in advance to be valid. The ABN applies to Original Medicare (Parts A and B); Medicare Advantage plans use their own pre-service coverage process.
Why not A: An ABN given after the fact is not valid.
Why not C: ABNs are a Medicare requirement, not a Medicaid form.
Why not D: Covered services do not need an ABN.
Exam tactic: ABN = before the service, when coverage is doubtful.
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