Certified Clinical Medical Assistant CCMA Practice Test

An MA is reviewing a Medicare claim denial. The assistant determines that there are charges that exceed the usual, customary, and reasonable fees. Which of the following actions should the assistant take?

1. Send the bill to the patient

2. Bill the insurance company again

3. Refuse to make any changes

4. Adjust the pt's account to reflect no unpaid charges and write off the balance

The correct answer is: Adjust the pt's account to reflect no unpaid charges and write off the balance

The MA should take the administrative action of adjusting the patient's account to reflect no unpaid charges and writing off the balance, as it is necessary for Medicare claims. Option A is incorrect because it puts the burden of payment on the patient, which is not the appropriate action for an MA to take. Option B is incorrect because the insurance company has already denied the claim. Option C is incorrect because the MA should take action to resolve the issue, not refuse to make any changes. Adjusting the patient's account ensures that the patient is not responsible for any unpaid charges and avoids any potential billing issues in the future.