Foundational Knowledge
9%of exam
Communication + Professionalism
19%of exam
TelephoneTherapeutic TalkWritten MessagesProfessional Conduct
Law Ethics Compliance
15%of exam
HIPAAConsentPatient RightsFraud Abuse
Scheduling
15%of exam
Patient Encounter
19%of exam
Billing + Revenue Cycle
10%of exam
CodingClaimsPaymentsDenials
Practice Procedures + Logistics
13%of exam
RecordsEHRInventoryOffice Safety
Quick Facts
- Exam
- NHA CMAA
- Items
- 135 total
- Scored
- 110 items
- Pretest
- 25 items
- Time
- 2 hours 15 minutes
- Pass
- 390/500
- Format
- Multiple choice
- Renewal
- 2 years + 10 CE
Medical Terms
- Prefix
- Word beginning
- Root
- Core meaning
- Suffix
- Word ending
- Cardi/o
- Heart
- Dermat/o
- Skin
- Gastr/o
- Stomach
- Nephr/o
- Kidney
- -itis
- Inflammation
Abbreviations
- U
- Write units
- IU
- Write international units
- QD
- Write daily
- QOD
- Write every other day
- Trailing zero
- Do not use
- Leading zero
- Use before decimal
- MS
- Write medication name
- TJC
- Safety standards
Care Models
- PCMH
- Coordinated primary care
- HMO
- Gatekeeper network
- PPO
- Flexible network
- EPO
- Network only
- POS
- HMO/PPO blend
- Urgent care
- Nonemergency acute care
- Ambulatory
- Outpatient care
- Home health
- Care at home
Phone Greeting
Practice, person, purpose.
PracticeYour nameOffer help
Communication Basics
- Active listening
- Attend and reflect
- Open question
- Broad patient response
- Closed question
- Specific answer
- Empathy
- Acknowledge feelings
- Clarifying
- Confirm meaning
- Silence
- Allows processing
- Plain language
- Avoid jargon
- Teach-back
- Patient repeats plan
Phone + Messages
- Greeting
- Practice, name, help
- Hold
- Ask permission first
- Transfer
- Explain destination
- Message
- Name, DOB, callback
- Urgent symptom
- Escalate immediately
- PHI voicemail
- Limit details
- Email PHI
- Secure channel only
- Complaint
- Acknowledge, apologize, update
HIPAA Core
Use least PHI needed.
Minimum necessaryTPOAuthorizationBreach
Privacy vs Security
Privacy
- PHI use
- Disclosure limits
Security
- ePHI safeguards
- Access controls
Use vs protect
Compliance Picker
- PHI request→Verify authorization(Identity)
- Care disclosure→TPO(Allowed)
- Family asks→Patient permission(Confirm)
- Legal subpoena→Office policy(Escalate)
- Suspected abuse→Mandatory report(Law)
- Scope unclear→Supervisor(Do not guess)
HIPAA + Compliance
- PHI
- Identifiable health data
- Privacy Rule
- Use and disclosure
- Security Rule
- ePHI safeguards
- TPO
- Treatment payment operations
- Minimum necessary
- Least PHI needed
- Authorization
- Specific written permission
- Breach
- Unauthorized disclosure
- OIG
- Compliance oversight
Fraud vs Abuse
Fraud
- Intentional deception
- False claim
Abuse
- Improper practice
- May be unintentional
Intentional vs improper
Law + Ethics
- Consent
- Permission for care
- Informed consent
- Risks explained
- Advance directive
- Future care wishes
- DNR
- No resuscitation order
- Scope
- Allowed role duties
- Fraud
- Intentional deception
- Abuse
- Improper practice
- Negligence
- Duty breach
Referral vs Auth
Referral
- Provider direction
- Specialist access
- Track report
Authorization
- Payer approval
- Before service
- Payment condition
Provider vs payer
Scheduling Picker
- Predictable visit→Stream(Specific time)
- Small delays likely→Wave(Shared arrival)
- Procedure block→Cluster(Similar setup)
- Provider unavailable→Matrix(Block schedule)
- Preventive due→Recall(Future contact)
- Missed visit→No-show policy(Document)
Scheduling Types
- Stream
- Fixed appointment times
- Wave
- Multiple same slot
- Modified wave
- Wave plus stream
- Open hours
- First come visits
- Cluster
- Similar visits grouped
- Double-book
- Two same slot
- Matrix
- Blocked unavailable time
- Recall
- Future preventive reminder
Referrals + Auths
- Referral
- Provider directs care
- Prior auth
- Payer approves service
- Precertification
- Admission approval
- Preauthorization
- Service approval
- No-show
- Missed appointment
- Cancellation
- Document reason
- Referral log
- Tracks completion
- Consult report
- Specialist response
Subjective vs Objective
Subjective
- Patient states
- Pain report
Objective
- Measured facts
- Observed data
Stated vs measured
Front Desk Picker
- New patient→Register(Demographics)
- Plan unknown→Eligibility(Coverage)
- Payment due→Copay(Receipt)
- Urgent symptom→Clinical triage(Escalate)
- Leaving visit→Checkout(Next steps)
- Specialist needed→Referral(Track report)
Check-In
- Identity
- Verify two identifiers
- Demographics
- Address, phone, guarantor
- Insurance card
- Scan both sides
- Eligibility
- Active coverage check
- Copay
- Collect per policy
- Consent forms
- Update signatures
- Chief complaint
- Visit reason
- Walk-in
- Follow triage policy
Checkout
- Follow-up
- Next appointment
- Referral packet
- Needed specialist info
- Orders
- Tests or imaging
- Patient balance
- Collect per policy
- Receipt
- Payment proof
- Portal invite
- Electronic access
- After-visit summary
- Visit instructions
- Tickler
- Future follow-up
Revenue Path
Register, code, claim, post, follow.
RegisterCodeClaimPostFollow
Copay vs Coinsurance
Copay
- Fixed amount
- Often upfront
Coinsurance
- Percentage share
- After deductible
Fixed vs percent
Revenue Cycle
- Registration
- Patient data captured
- Eligibility
- Coverage verified
- Coding
- Codes assigned
- CMS-1500
- Professional claim
- Clearinghouse
- Claim scrubber
- EOB
- Patient explanation
- ERA
- Electronic remittance
- Aging report
- Unpaid accounts
ICD vs CPT
ICD-10-CM
- Diagnosis
- Why treated
CPT
- Procedure
- What performed
Why vs what
Coding + Payment
- ICD-10-CM
- Diagnosis codes
- CPT
- Procedure codes
- HCPCS II
- Supplies and drugs
- Modifier
- Code detail
- Deductible
- Before plan pays
- Copay
- Fixed patient cost
- Coinsurance
- Percentage patient share
- COB
- Payer order
Fire RACE
Rescue, alarm, contain, extinguish.
RescueAlarmContainExtinguish
EMR vs EHR
EMR
- One practice
- Medical record
EHR
- Shared record
- Broader access
Local vs shared
Records + Logistics
- EHR
- Electronic health record
- EMR
- Office medical record
- ROI
- Release information
- Retention
- Keep per law
- Destruction
- Secure shredding
- Alphabetic filing
- Name order
- Terminal digit
- Number grouping
- Audit trail
- Access history
Office Operations
- Inventory
- Supply tracking
- Par level
- Minimum stock
- FIFO
- Oldest used first
- Packing slip
- Delivery contents
- Purchase order
- Approved order
- SDS
- Chemical safety sheet
- RACE
- Fire response
- PASS
- Extinguisher steps
Common Traps
Pretest Items
Not identified ≠ Answer all
CMAA Scope
Administrative support ≠ No diagnosis
Authorization
Approval before service ≠ No payment guarantee
No-Show
Document missed visit ≠ Do not delete
PHI Voicemail
Limit details ≠ Verify permission
TJC Abbreviations
U is unsafe ≠ Write units
Patient Complaint
Acknowledge first ≠ Avoid arguing
Record Release
Verify authority ≠ Log disclosure
Last Minute
- 1.110 scored, 25 pretest
- 2.Time: 2 hours 15 minutes
- 3.Communication plus encounters: 38%
- 4.Answer every item
- 5.CMAA does not diagnose
- 6.Referral is provider direction
- 7.Auth is payer approval
- 8.HIPAA: minimum necessary
- 9.ICD explains why
- 10.CPT explains what
- 11.No-shows stay documented
- 12.Scope unclear: escalate
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