CPMA EXAM EXAMINATION TEST 2026
COMPLETE QUESTIONS WITH SOLUTIONS
GRADED A+
⩥ FFS. Answer: Fee-For-Service
⩥ Prepayment Review. Answer: Review of claims prior to payment.
Prepayment reviews result in an initial determination.
⩥ Postpayment Review. Answer: Review of claims after payment. May
result in either no change to the initial determination or a revised
determination, indicating an underpayment or overpayment.
⩥ Underpayment. Answer: A payment a provider receives under the
amount due for services furnished under the Medicare statute and
regulations.
⩥ Overpayment. Answer: A payment a provider receives over the
amount due for services furnished under Medicare statutes and
regulations
⩥ 5 Common reasons for overpayment are:. Answer: *Billing for
excessive and subsequent payment of the same service or claim.
*Duplicate submission and payment for same service or claim
,*Payment for excluded or Medically unnecessary services.
*Payment for services in setting not appropriate to pt's needs or
condition
*Payment to an incorrect payee.
⩥ MACs. Answer: Medicare Administrative Contractors
⩥ MAC Responsibilities. Answer: Process claims from physicians,
hospitals, and other health care professionals, and submit payment to
those providers according to Medicare rules and regulations (including
identifying under- and overpayments).
⩥ ZPICs. Answer: Zone Program Integrity Contractors
⩥ PSCs. Answer: Program Safeguard Contractor
⩥ ZPICs/PSCs. Answer: Perform investigations that are unique and
tailored to specific circumstances and occur only in situations where
there is potential fraud, and take appropriate corrective actions
⩥ SMRC. Answer: Supplemental Medical Review Contractor
,⩥ SMRC Responsibilities. Answer: Conduct nationwide medical review
as directed by CMS (includes identifying underpayments and
overpayments
⩥ Medicare FFS Recovery Auditors. Answer: Review claims to identify
potential underpayments and overpayments in Medicare FFS, as part of
the Recovery Audit Program
⩥ Zone 6. Answer: All PSCs transitioned to ZPICs with the exception of
Zone 6
⩥ While all contractors focus on a specific area,. Answer: Each
contractor conducting a claim review must apply all Medicare policies to
the claim under review. Additionally, once a claim is reviewed, a
different contractor should not reopen it. Therefore, it is important when
conducting claim reviews, contractors review each claim in its entirety.
⩥ Claim Review Programs. Answer: There are 5 claim review programs
⩥ NCCI Edits. Answer: National Correct Coding Initiative Editor
⩥ NCCI Edits are performed by. Answer: Macs, ZPICs, CERT, and
Medicare FFS
Complexity: Non-complex
, ⩥ CMS developed the NCCI to. Answer: Promote national correct
coding methods and to control improper coding that leads to
inappropriate payment in Medicare Part B claims. NCCI Edits prevent
improper payments when incorrect code combinations are reported. The
NCCI Edits are updated quarterly.
⩥ The coding policies are based on the following coding conventions....
Answer: *American Medical Association (AMA) Current Procedure
Terminology (CPT) Manual
*National and local Medicare policies and edits
*Coding guidelines developed by the National societies, standard
medical and surgical practice, and current coding practice.
⩥ PTP. Answer: Procedure-to-Procedure edits
⩥ Column One/Column Two edit pair. Answer: If a claim contains the
two codes of an edit pair, the Column One code is eligible for payment,
but CMS will deny the Column Two code
⩥ NCCI edit pairs that are both appropriate. Answer: If both codes are
clinically appropriate, you must append with an appropriate NCCI-
associated modifier to be eligible for payment.
COMPLETE QUESTIONS WITH SOLUTIONS
GRADED A+
⩥ FFS. Answer: Fee-For-Service
⩥ Prepayment Review. Answer: Review of claims prior to payment.
Prepayment reviews result in an initial determination.
⩥ Postpayment Review. Answer: Review of claims after payment. May
result in either no change to the initial determination or a revised
determination, indicating an underpayment or overpayment.
⩥ Underpayment. Answer: A payment a provider receives under the
amount due for services furnished under the Medicare statute and
regulations.
⩥ Overpayment. Answer: A payment a provider receives over the
amount due for services furnished under Medicare statutes and
regulations
⩥ 5 Common reasons for overpayment are:. Answer: *Billing for
excessive and subsequent payment of the same service or claim.
*Duplicate submission and payment for same service or claim
,*Payment for excluded or Medically unnecessary services.
*Payment for services in setting not appropriate to pt's needs or
condition
*Payment to an incorrect payee.
⩥ MACs. Answer: Medicare Administrative Contractors
⩥ MAC Responsibilities. Answer: Process claims from physicians,
hospitals, and other health care professionals, and submit payment to
those providers according to Medicare rules and regulations (including
identifying under- and overpayments).
⩥ ZPICs. Answer: Zone Program Integrity Contractors
⩥ PSCs. Answer: Program Safeguard Contractor
⩥ ZPICs/PSCs. Answer: Perform investigations that are unique and
tailored to specific circumstances and occur only in situations where
there is potential fraud, and take appropriate corrective actions
⩥ SMRC. Answer: Supplemental Medical Review Contractor
,⩥ SMRC Responsibilities. Answer: Conduct nationwide medical review
as directed by CMS (includes identifying underpayments and
overpayments
⩥ Medicare FFS Recovery Auditors. Answer: Review claims to identify
potential underpayments and overpayments in Medicare FFS, as part of
the Recovery Audit Program
⩥ Zone 6. Answer: All PSCs transitioned to ZPICs with the exception of
Zone 6
⩥ While all contractors focus on a specific area,. Answer: Each
contractor conducting a claim review must apply all Medicare policies to
the claim under review. Additionally, once a claim is reviewed, a
different contractor should not reopen it. Therefore, it is important when
conducting claim reviews, contractors review each claim in its entirety.
⩥ Claim Review Programs. Answer: There are 5 claim review programs
⩥ NCCI Edits. Answer: National Correct Coding Initiative Editor
⩥ NCCI Edits are performed by. Answer: Macs, ZPICs, CERT, and
Medicare FFS
Complexity: Non-complex
, ⩥ CMS developed the NCCI to. Answer: Promote national correct
coding methods and to control improper coding that leads to
inappropriate payment in Medicare Part B claims. NCCI Edits prevent
improper payments when incorrect code combinations are reported. The
NCCI Edits are updated quarterly.
⩥ The coding policies are based on the following coding conventions....
Answer: *American Medical Association (AMA) Current Procedure
Terminology (CPT) Manual
*National and local Medicare policies and edits
*Coding guidelines developed by the National societies, standard
medical and surgical practice, and current coding practice.
⩥ PTP. Answer: Procedure-to-Procedure edits
⩥ Column One/Column Two edit pair. Answer: If a claim contains the
two codes of an edit pair, the Column One code is eligible for payment,
but CMS will deny the Column Two code
⩥ NCCI edit pairs that are both appropriate. Answer: If both codes are
clinically appropriate, you must append with an appropriate NCCI-
associated modifier to be eligible for payment.
