26 Care Coordination & Administration Practice Questions & Answers

1. 1. While reviewing charts the day before clinic, a medical assistant notes that a 52-year-old patient scheduled for a blood pressure follow-up has no colorectal cancer screening on record. What is the most appropriate action?

   • A.Schedule a colonoscopy for the patient before the provider sees him
   • B.Flag the care gap so the provider can address it at the visit✓ Answer
   • C.Leave it alone because screening is not the reason for the visit
   • D.Call the patient and tell him he is overdue for a colonoscopy

   Pre-visit chart review (scrubbing) exists to find care gaps such as overdue screenings so they can be addressed at any visit, not only preventive ones. The medical assistant flags the gap for the provider; choosing and ordering the screening method (colonoscopy, stool-based test, or another option) is the provider's decision, so scheduling a colonoscopy or telling the patient one is overdue goes beyond MA scope.

   Ref QB-39X8YBSource: NHA CCMA Test Plan — Domain 4 Patient Care Coordination: pre-visit chart review and preventive screening documentation (USPSTF colorectal cancer screening)Report a problem with this question

2. 2. A provider tells a patient to return for a repeat screening in one year. Which office process best ensures the patient is reminded when the screening becomes due?

   • A.Writing the due date on the patient's visit receipt
   • B.Asking the patient to call when she remembers it
   • C.Noting it in the progress note with no reminder set
   • D.Entering the due date into a recall (tickler) system✓ Answer

   A recall or tickler system (paper file or EHR alert) stores future due dates and prompts staff to contact the patient when the date arrives, so tracking does not depend on anyone's memory. A note in the chart documents the plan but does not generate a reminder, and relying on the patient or a receipt leaves the screening likely to be missed.

   Ref QB-MRFRQDSource: NHA CCMA Test Plan — Domain 4 Patient Care Coordination: tracking screening recommendations with recall/tickler systemsReport a problem with this question

3. 3. A practice reports the percentage of its eligible female patients who have a current mammogram on record. What is this figure an example of?

   • A.A clinical quality measure✓ Answer
   • B.A prior authorization rate
   • C.A coinsurance percentage
   • D.A practice's aging report

   A clinical quality measure tracks how well a practice delivers recommended care across a defined patient population, such as the breast cancer screening rate used in HEDIS and MIPS reporting. Medical assistants help improve these measures by identifying patients who are due and flagging them for the provider.

   Ref QB-49AK5DSource: NHA CCMA Test Plan — Domain 4 Patient Care Coordination: clinical quality measuresReport a problem with this question

4. 4. An older patient has missed two follow-up visits and explains that she no longer drives and cannot afford a taxi. After informing the provider, which resource should the medical assistant help her find?

   • A.A medical transportation assistance program✓ Answer
   • B.A durable medical equipment supply company
   • C.A hospice program for end-of-life care
   • D.A home health agency for skilled nursing

   The barrier here is transportation, a socioeconomic barrier, so the matching non-clinical resource is a transportation assistance program or voucher. Home health, DME suppliers, and hospice are clinical services that address medical needs the patient has not described, and none of them gets her to her appointments.

   Ref QB-HRDR7ASource: NHA CCMA Test Plan — Domain 4 Patient Care Coordination: community resources (non-clinical services such as transportation vouchers) and barriers to careReport a problem with this question

5. 5. A patient's daughter is the main caregiver for her father, who has dementia and cannot be left alone while she works during the day. Which community resource best fits this need?

   • A.Outpatient physical therapy
   • B.Adult day care services✓ Answer
   • C.A transportation voucher
   • D.Home-delivered meal service

   Adult day care provides supervised daytime activities, meals, and safety for adults with cognitive or functional impairment, which gives working caregivers respite. Meal delivery, therapy, and transportation each solve a different problem and do not provide daytime supervision.

   Ref QB-Z88KM9Source: NHA CCMA Test Plan — Domain 4 Patient Care Coordination: community resources (adult day care, caregiver respite)Report a problem with this question

6. 6. In a patient-centered medical home (PCMH), which role does a medical assistant commonly take on as part of the care team?

   • A.Deciding which specialist each patient should see
   • B.Negotiating payer contracts for the whole network
   • C.Coordinating follow-up care and tracking care gaps✓ Answer
   • D.Diagnosing minor illnesses to free the provider's time

   A PCMH delivers comprehensive, coordinated primary care through a team led by the provider, and medical assistants often serve as care coordinators and health coaches who schedule follow-ups, close care gaps, and track referrals. Diagnosing and choosing specialists are provider decisions, and payer contracting is an administrative leadership function.

   Ref QB-JRR3DBSource: NHA CCMA Test Plan — Domain 4 Patient Care Coordination: team-based care roles (PCMH)Report a problem with this question

7. 7. A patient is discharged from the hospital and comes in for a follow-up visit with a new list of medications. What should the medical assistant do with the discharge medication list?

   • A.File it in the chart without review, since the hospital wrote it
   • B.Replace the office list with it, since the hospital list is newest
   • C.Tell the patient to stop any drug that is not on the new list
   • D.Compare it with the office list and flag differences to the provider✓ Answer

   Transitions of care are a high-risk point for medication errors, so medication reconciliation compares the discharge list with the office list and the patient's actual use, and any discrepancies go to the provider to resolve. Overwriting the list, filing it unreviewed, or telling the patient to stop drugs would bypass the provider's decision.

   Ref QB-29KWSASource: NHA CCMA Test Plan — Domain 4 Patient Care Coordination: transitions of care and medication reconciliationReport a problem with this question

8. 8. A patient admits he has been skipping doses of a prescribed medication because he cannot afford the refills. What is the medical assistant's best response?

   • A.Advise him to take half doses so the supply lasts twice as long
   • B.Offer him sample medication without asking the provider
   • C.Remind him firmly that skipping doses can harm his health
   • D.Tell the provider and share information on assistance programs✓ Answer

   Cost is a socioeconomic barrier to adherence, and the effective response identifies the barrier, informs the provider (who may consider a lower-cost alternative), and connects the patient with resources such as patient assistance programs. Changing the dose or dispensing samples on the MA's own initiative is outside scope, and lecturing does not remove the barrier.

   Ref QB-FRP3V7Source: NHA CCMA Test Plan — Domain 4 Patient Care Coordination: facilitating patient compliance and socioeconomic barriers to careReport a problem with this question

9. 9. After explaining a new home-care instruction, a medical assistant asks the patient, "Can you tell me in your own words how you will do this at home?" What technique is this?

   • A.The teach-back method✓ Answer
   • B.A summarizing statement
   • C.A reflective response
   • D.A closed-ended question

   Teach-back asks the patient to restate or demonstrate the instructions in their own words, which checks understanding rather than assuming it and lets the staff member correct gaps right away. A closed-ended question invites only yes or no, and reflective or summarizing statements come from the staff member, not the patient.

   Ref QB-X8HW97Source: NHA CCMA Test Plan — Domain 4 Patient Education: teach-back method (AHRQ Health Literacy Universal Precautions)Report a problem with this question

10. 10. A patient tells the medical assistant he learns best by doing things with his hands. The provider has prescribed a metered-dose inhaler with a spacer. Which teaching approach best fits this patient?

    • A.Giving him a printed handout with labeled diagrams to read
    • B.Having him practice with the device and demonstrate it back✓ Answer
    • C.Explaining each step aloud while he listens carefully
    • D.Sending him a link to a video to watch later at home

    A kinesthetic learner learns by doing, so hands-on practice followed by a return demonstration matches his style and also confirms he can use the device correctly. Diagrams and videos suit visual learners, and verbal explanation suits auditory learners.

    Ref QB-WHKFK7Source: NHA CCMA Test Plan — Domain 4 Patient Education: education delivery methods and learning styles (kinesthetic, return demonstration)Report a problem with this question

11. 11. During a video visit, a medical assistant reviews the provider's instructions for a newly prescribed medication with a patient. What is the best way to confirm the patient understood?

    • A.Email the instructions to the patient's personal address afterward
    • B.Ask the patient to explain the plan back, then send a portal handout✓ Answer
    • C.Ask the patient whether they have any questions before ending
    • D.Read the instructions twice, slowly, and then end the session

    In telehealth education the staff member cannot watch the patient handle printed materials, so understanding is confirmed verbally with teach-back and reinforced with written instructions sent through the secure patient portal. Asking 'any questions?' often gets a polite 'no' without real understanding, repeating the instructions does not check comprehension, and unsecured personal email is not an appropriate channel for health information.

    Ref QB-E2SM68Source: NHA CCMA Test Plan — Domain 4 Patient Education: patient education via telehealthReport a problem with this question

12. 12. A parent asks how to keep a coughing child from spreading a respiratory infection to siblings at home. Which advice reflects standard respiratory etiquette?

    • A.Cough into a tissue or elbow, discard the tissue, then wash hands✓ Answer
    • B.Cover only loud coughs, since quiet coughs do not spread germs
    • C.Cough into the bare hands, then wipe them on clothing right away
    • D.Keep a used tissue in a pocket to reuse for the rest of the day

    Respiratory etiquette means covering every cough or sneeze with a tissue or the inner elbow, throwing the tissue away right after use, and then cleaning the hands, because droplets and contaminated hands both spread respiratory pathogens. Coughing into bare hands transfers germs to surfaces, reused tissues stay contaminated, and any cough can release infectious droplets.

    Ref QB-XHXSR8Source: CDC Respiratory Hygiene/Cough Etiquette guidance; NHA CCMA Test Plan — Domain 4: education on communicable disease preventionReport a problem with this question

13. 13. A primary care practice referred a patient to a cardiologist three weeks ago. Which step closes the referral loop?

    • A.Confirming the patient's copay for the specialist visit was paid
    • B.Confirming the consult report was received and routed to the PCP✓ Answer
    • C.Confirming the patient was given the specialist's phone number
    • D.Confirming the referral form was faxed to the specialist's office

    Referral tracking is complete only when the patient has been seen and the specialist's consult report has come back and been routed to the referring provider for review, which keeps care continuous. Sending the form or giving the patient a phone number only starts the loop, and copay collection is a billing step, not care coordination.

    Ref QB-F25YB9Source: NHA CCMA Test Plan — Domain 4 Patient Care Coordination: referral forms and processes; continuity of careReport a problem with this question

14. 14. A clinic books all of its prenatal visits on Tuesday mornings and all of its sports physicals on Thursday afternoons. Which scheduling method is this?

    • A.Clustering by visit type✓ Answer
    • B.Open-access scheduling
    • C.Time-specified streaming
    • D.Modified wave scheduling

    Clustering (categorization) groups similar appointment types into dedicated blocks so the right staff, rooms, and supplies are ready for them. Open access holds slots for same-day requests, stream scheduling gives each patient an individual time, and modified wave books several patients at the start of the hour followed by single appointments.

    Ref QB-UHVS85Source: NHA CCMA Test Plan — Domain 5 Administrative Assisting: appointment scheduling methodsReport a problem with this question

15. 15. A patient calls to say she has had a sore throat and a fever of 101°F since yesterday. She is drinking fluids and breathing normally. How should the medical assistant schedule her?

    • A.Book a routine visit in the next open slot two weeks out
    • B.Tell her to call 911 because she has a fever
    • C.Offer a same-day sick visit with the provider✓ Answer
    • D.Add her to the list for her next annual physical

    A new acute illness such as a sore throat with fever needs to be seen promptly but is not life-threatening when the patient is breathing and drinking normally, so it fits a same-day sick visit. Emergency services are for warning signs like trouble breathing or chest pain, while a routine slot weeks away or a wellness physical would delay evaluation of an illness that is happening now.

    Ref QB-C23YT5Source: NHA CCMA Test Plan — Domain 5 Administrative Assisting: determining appointment type and prioritizing by urgencyReport a problem with this question

16. 16. A patient was seen two years ago by a family physician in a group practice. Today she sees a different family physician in the same group for the first time. How is today's visit classified for billing?

    • A.Established, because she was seen in the group within 3 years✓ Answer
    • B.New, because more than one year has passed since her visit
    • C.Established only if her insurance has not changed since then
    • D.New, because she has never seen this particular physician

    Under CPT evaluation and management rules, a patient is established if she received professional services from a physician of the same specialty in the same group within the past 3 years. The visit is therefore established even with a different physician, and a change in insurance does not affect new versus established status.

    Ref QB-VH85E6Source: CPT Evaluation and Management guidelines: new vs established patient (3-year rule); NHA CCMA Test Plan — Domain 5: visit typesReport a problem with this question

17. 17. An established patient checks in for a routine visit and mentions she started a new job last month. What should the medical assistant do at check-in?

    • A.Update the insurance after the visit, when the claim is created
    • B.Use the insurance on file, since her last claim was paid in full
    • C.Copy only the front of the new card, since the back is not needed
    • D.Ask for her current card, scan both sides, and verify eligibility✓ Answer

    A job change often means a change in coverage, so the current card is copied front and back (the back holds claims addresses and payer phone numbers) and eligibility is verified before the visit. A paid past claim does not prove current coverage, and updating insurance only after the visit leads to denied claims and missed copays.

    Ref QB-D2EAZ6Source: NHA CCMA Test Plan — Domain 5 Administrative Assisting: check-in and insurance eligibility verificationReport a problem with this question

18. 18. A patient's plan has an annual deductible with $200 still unmet and 20% coinsurance after the deductible. The allowed amount for today's service is $500. How much does the patient owe?

    • A.$300
    • B.$200
    • C.$260✓ Answer
    • D.$100

    The deductible is paid first: the patient pays the remaining $200, leaving $300 of the allowed amount. Coinsurance then applies to that remainder, and 20% of $300 is $60, so the patient owes $200 + $60 = $260. Taking 20% of the full $500 or adding the deductible to 20% of $500 ignores that the deductible portion is not split.

    Ref QB-2JZS9CSource: NHA CCMA Test Plan — Domain 5 Administrative Assisting: insurance terminology (deductible, coinsurance, allowed amount)Report a problem with this question

19. 19. A patient reaches her plan's out-of-pocket maximum in the middle of the year. What happens to her cost sharing for covered in-network services for the rest of the plan year?

    • A.Her deductible starts over at the full amount again
    • B.Her coinsurance drops to half its usual percentage
    • C.She pays only premiums and copays, not coinsurance
    • D.The plan pays 100% of covered in-network services✓ Answer

    The out-of-pocket maximum caps what the patient pays in deductibles, copays, and coinsurance for covered in-network care in a plan year; once it is reached, the plan pays 100% of covered in-network services until the year resets. Premiums still must be paid, but copays and coinsurance stop, and the deductible resets only at the start of a new plan year.

    Ref QB-J27YUCSource: NHA CCMA Test Plan — Domain 5 Administrative Assisting: insurance fundamentals (out-of-pocket maximum)Report a problem with this question

20. 20. A primary care provider (PCP) sends a patient to a cardiologist, and the patient's plan also requires approval before a stress test. How do a referral and a prior authorization differ?

    • A.The referral comes from the payer; the authorization from the PCP
    • B.They are two names for the same form and are filed only once
    • C.A referral is needed only after the payer denies the authorization
    • D.The PCP's referral sends the patient on; the payer authorizes the test✓ Answer

    A referral is the primary care provider's order sending the patient to a specialist, while a prior authorization is the payer's advance approval that a specific service, such as the stress test, is medically necessary and covered. A plan can require both, and having one does not replace the other.

    Ref QB-9TAB6YSource: NHA CCMA Test Plan — Domain 5 Administrative Assisting: referrals, prior authorizations and precertificationsReport a problem with this question

21. 21. On a claim, which code set explains WHY a service was performed, and which describes WHAT service the provider performed?

    • A.CPT explains why; ICD-10-CM describes what
    • B.HCPCS Level II explains why; CPT describes what
    • C.ICD-10-CM explains why; CPT describes what✓ Answer
    • D.CPT explains why; HCPCS Level II describes what

    ICD-10-CM codes report diagnoses, symptoms, and reasons for the encounter, which establishes medical necessity, while CPT codes report the procedures and services the provider performed. HCPCS Level II covers supplies, drugs, equipment, and other items not in CPT, and neither CPT nor HCPCS reports the diagnosis.

    Ref QB-RA56KXSource: NHA CCMA Test Plan — Domain 5 Administrative Assisting: diagnostic and procedural code sets (ICD-10-CM, CPT, HCPCS Level II)Report a problem with this question

22. 22. A patient enrolled in a Medicare Advantage plan wants a service the provider thinks may not be covered. What should the office do before the service to clarify coverage?

    • A.Bill Original Medicare first and wait for a denial notice
    • B.Have the patient sign a general waiver of all liability
    • C.Request a pre-service coverage decision from the MA plan✓ Answer
    • D.Have the patient sign an Advance Beneficiary Notice form

    The ABN is used only for Original (fee-for-service) Medicare; Medicare Advantage plans handle coverage questions through their own pre-service organization (coverage) determination, which the patient or provider requests from the plan. A blanket liability waiver does not meet Medicare requirements, and an MA enrollee's claims go to the MA plan, not Original Medicare.

    Ref QB-ATNNBZSource: CMS ABN (Form CMS-R-131) instructions — Original Medicare only; Medicare Advantage organization determinations (42 CFR 422.566)Report a problem with this question

23. 23. An accounts receivable aging report shows balances in the 0-30, 31-60, 61-90, and over-90-day columns. Which accounts should generally receive collection follow-up first?

    • A.Those in the 0-30 day column
    • B.Those with the smallest balances
    • C.Those with the newest charges
    • D.Those in the over-90-day column✓ Answer

    An aging report sorts unpaid balances by how long they have been outstanding, and the likelihood of collecting a balance drops as it ages, so the oldest accounts (over 90 days) get priority follow-up. Recent balances in the 0-30 day column are usually still within normal payment time.

    Ref QB-SAGGRYSource: NHA CCMA Test Plan — Domain 5 Administrative Assisting: aging reports and collectionsReport a problem with this question

24. 24. A payer denies a claim as not medically necessary, but the provider's documentation clearly supports the service. What is the appropriate next step?

    • A.File an appeal with supporting records within the payer's deadline✓ Answer
    • B.Bill the patient for the full charge, since the payer has refused
    • C.Resubmit the same claim unchanged until the payer finally pays it
    • D.Change the diagnosis code to one the payer is more likely to cover

    When a denial is wrong and the documentation supports the service, the practice files an appeal with the supporting records before the payer's deadline. Resubmitting an unchanged claim is treated as a duplicate, changing a diagnosis code to win payment when the record does not support it is fraud, and billing the patient may violate the payer contract.

    Ref QB-7TKNTVSource: NHA CCMA Test Plan — Domain 5 Administrative Assisting: appeals and denials; False Claims Act (31 U.S.C. 3729)Report a problem with this question

25. 25. A practice files paper charts using the terminal-digit system. A chart with the record number 48-31-07 is filed primarily by which set of digits?

    • A.48, the first pair of digits
    • B.07, the last pair of digits✓ Answer
    • C.All six digits, left to right
    • D.31, the middle pair of digits

    Terminal-digit filing reads the record number from right to left in pairs: the last pair (07) is the primary filing unit, the middle pair (31) is secondary, and the first pair (48) is tertiary. This spreads new records evenly across the file section instead of crowding them at the end, as straight numeric filing does.

    Ref QB-PAEG8VSource: NHA CCMA Test Plan — Domain 5 Administrative Assisting: managing paper records (terminal-digit filing)Report a problem with this question

26. 26. A new shipment of exam gloves and syringes arrives. How should the medical assistant shelve the new stock?

    • A.In front of the older stock so the new items are used first
    • B.In a separate room until all older stock has been discarded
    • C.Behind the older stock so the older items are used first✓ Answer
    • D.Mixed in with older stock in no set order to save time

    Supplies are rotated first-in, first-out (FIFO): new stock goes behind older stock so the items with the earliest expiration dates are used before they expire, which reduces waste. Putting new items in front or mixing them lets older stock expire on the shelf, and discarding usable stock is wasteful.

    Ref QB-8TXYYWSource: NHA CCMA Test Plan — Domain 5 Administrative Assisting: supply inventory (FIFO stock rotation)Report a problem with this question

Practice questions built from the domains and task statements in the National Healthcareer Association's published CCMA test plan. This site is not affiliated with or endorsed by NHA, and these are not real exam questions. Eligibility rules, fees, scoring and the exam format are set by NHA and can change, so confirm them on NHA's site before you register. What a medical assistant may do also depends on state law and employer policy. About the CCMA (NHA) →