AAPC CPMA CERTIFICATION EXAM
PREP CORRECT 100%
Regarding time, what MUST the physical therapy provider include on the PT log? -
ANSWERTime IN and Time OUT.
What information should be reported to the OIG in the claims review findings as part of
an entity's Annual Report? - ANSWERClaims review methodology, statistical sampling
documentation, and claim review findings.
An analysis that provides an organization an overview of the deficit areas captured by a
medical record audit is called what? - ANSWERAn aggregate analysis.
Under what circumstances may providers use or disclose PHI w/o patient consent? -
ANSWERPayment, treatment, and operations.
What program was established by HIPAA to combat fraud & abuse committed against
all health plans both public & private? - ANSWERHealthcare Fraud & Abuse Control
Program
What is the minimum signature requirement of the author entry in a medical record? -
ANSWERThe first initial, the last name, and credentials.
As an auditor, who of the following would NOT be expected to submit operative notes? -
ANSWERA surgical assistant.
A patient can request copies of disclosure of PHI under HIPAA: - ANSWERFor a 6-year
period.
Can entries for medical records ever be made in advance? - ANSWERNO. The medical
record should NEVER be prepared in advance.
Based on Joint Commission accreditation guidance for personal data, what 2 elements
must be evident in the medical record? - ANSWERPersonal biographical data and
consent for treatment or authorization for treatment form.
A full sample must be reviewed, and a systems review must be conducted when he net
financial error rate of the sampling equals or exceeds what percent? - ANSWER5%
When can a RAC extrapolate the overpayment(s) on claims? - ANSWERIf a RAC can
demonstrate a high level of error, the RAC can then extrapolate the findings & request a
refund.
, For civil monetary penalties for false or fraudulent claims, up to how many times of the
amount are damages for each false claim submitted? - ANSWERUp to three (3) times
the amount improperly claimed.
The Stark Statue applies to: - ANSWEROnly physicians who refer Medicare & Medicaid
patients to entities for designated health care services with which the provider or
immediate family member has a financial relationship.
Codes 45385 and 45380 - Modifier -59 - ANSWERModifier 59 is only appropriate if the
2 procedures are performed on separate lesions or at separate patient encounters.
A comprehensive audit is: - ANSWERA selection of a large # of claims that are selected
for a review that might be focused on specific procedure and / or diagnosis codes.
A provider receives a denial on a Medicare claim due to lack of medical necessity.
Which resource is a valuable tool for providers to limit denials for medical necessity? -
ANSWERLCD's with associated articles.
How many claims does the OIG's Recommended Compliance plan recommend be
audited per year? - ANSWER10 records per provider each year.
Which of the following statements is TRUE? - ANSWERThe codes for the
anesthesiologist and CRNA are submitted on the SAME CLAIM if they belong to the
SAME PRACTICE.
Which type of health plan is exempt from HIPAA? - ANSWEREmployer health plan that
the employer solely establishes and maintains, fewer than 50 participants.
What standards are set by the Privacy Rule? - ANSWERStandards for how protected
health information is used.
When a laboratory report has abnormal findings, what should be documented? -
ANSWERCircle and sign the abnormal finding and address the abnormality in the
diagnosis.
Under the reverse false claims provision under the FCA, what must be understood by
an auditor? - ANSWERDeclaring an audit error w/o binding standards can
inappropriately expose the audited provider to FCA liability.
What is an auditor's role in the OIG Self-Disclosure Protocol? (SDP) -
ANSWERIdentifying the scope of the error and auditing the documentation.
What type of insurance carrier might be considered a state-regulated commercial
insurance plan? - ANSWERWorker's Comp
PREP CORRECT 100%
Regarding time, what MUST the physical therapy provider include on the PT log? -
ANSWERTime IN and Time OUT.
What information should be reported to the OIG in the claims review findings as part of
an entity's Annual Report? - ANSWERClaims review methodology, statistical sampling
documentation, and claim review findings.
An analysis that provides an organization an overview of the deficit areas captured by a
medical record audit is called what? - ANSWERAn aggregate analysis.
Under what circumstances may providers use or disclose PHI w/o patient consent? -
ANSWERPayment, treatment, and operations.
What program was established by HIPAA to combat fraud & abuse committed against
all health plans both public & private? - ANSWERHealthcare Fraud & Abuse Control
Program
What is the minimum signature requirement of the author entry in a medical record? -
ANSWERThe first initial, the last name, and credentials.
As an auditor, who of the following would NOT be expected to submit operative notes? -
ANSWERA surgical assistant.
A patient can request copies of disclosure of PHI under HIPAA: - ANSWERFor a 6-year
period.
Can entries for medical records ever be made in advance? - ANSWERNO. The medical
record should NEVER be prepared in advance.
Based on Joint Commission accreditation guidance for personal data, what 2 elements
must be evident in the medical record? - ANSWERPersonal biographical data and
consent for treatment or authorization for treatment form.
A full sample must be reviewed, and a systems review must be conducted when he net
financial error rate of the sampling equals or exceeds what percent? - ANSWER5%
When can a RAC extrapolate the overpayment(s) on claims? - ANSWERIf a RAC can
demonstrate a high level of error, the RAC can then extrapolate the findings & request a
refund.
, For civil monetary penalties for false or fraudulent claims, up to how many times of the
amount are damages for each false claim submitted? - ANSWERUp to three (3) times
the amount improperly claimed.
The Stark Statue applies to: - ANSWEROnly physicians who refer Medicare & Medicaid
patients to entities for designated health care services with which the provider or
immediate family member has a financial relationship.
Codes 45385 and 45380 - Modifier -59 - ANSWERModifier 59 is only appropriate if the
2 procedures are performed on separate lesions or at separate patient encounters.
A comprehensive audit is: - ANSWERA selection of a large # of claims that are selected
for a review that might be focused on specific procedure and / or diagnosis codes.
A provider receives a denial on a Medicare claim due to lack of medical necessity.
Which resource is a valuable tool for providers to limit denials for medical necessity? -
ANSWERLCD's with associated articles.
How many claims does the OIG's Recommended Compliance plan recommend be
audited per year? - ANSWER10 records per provider each year.
Which of the following statements is TRUE? - ANSWERThe codes for the
anesthesiologist and CRNA are submitted on the SAME CLAIM if they belong to the
SAME PRACTICE.
Which type of health plan is exempt from HIPAA? - ANSWEREmployer health plan that
the employer solely establishes and maintains, fewer than 50 participants.
What standards are set by the Privacy Rule? - ANSWERStandards for how protected
health information is used.
When a laboratory report has abnormal findings, what should be documented? -
ANSWERCircle and sign the abnormal finding and address the abnormality in the
diagnosis.
Under the reverse false claims provision under the FCA, what must be understood by
an auditor? - ANSWERDeclaring an audit error w/o binding standards can
inappropriately expose the audited provider to FCA liability.
What is an auditor's role in the OIG Self-Disclosure Protocol? (SDP) -
ANSWERIdentifying the scope of the error and auditing the documentation.
What type of insurance carrier might be considered a state-regulated commercial
insurance plan? - ANSWERWorker's Comp
