CPMA QUIZ| WITH COMPLETE SOLUTION| UPDATED
RATED A+ 2026
The Joint Commission (JC) requires the Factors that Affect Learning must be assessed for a
hospital or hospital owned physician prac ce as well as other health care facili es. When
assessing this element what does this include?
A. The pa ent's ability to read, method of learning and understanding.
B. Any language or physical disabili es.
C. Cultural beliefs.
D. All the above
D. All the above
Report copies and printouts, films, scans, and other radio logic service image records must be
retained for how long according to Federal Regula ons?
A. 10 years
B. 7 years
C. 5 years
D. 3 years
C. 5 years
At which point should a provider repay over payments reported by self-disclosure to the office
of Inspector General?
A. Make the payment to your carrier immediately.
B. Make the payment at the conclusion of the OIG injury.
C. Make the payment to the carrier prior to the self disclosure.
D. Make the payment to the OIG with a self disclosure report.
,B. Make the payment at the conclusion of the OIG injury
Which of the following may be considered essen al element (s) of an opera ve report and will
allow for accurate coding?
A. The approach
B. The type of anesthesia required
C. The loca on and severity of wounds repaired
D. All of the above
D. All of the above
Which of the following is NOT a covered en ty under HIPPA?
A. Physician
B. Health Plan
C. Health Care Consultant
D. Physician Assistant
C. Health Care Consultant
When referring to the authen ca on of a medical record entry, what does this entail?
A. Legible signature of author and date signed
B. A physician's order for ancillary services
C. An original document filed in the record
D. The pa ent's personal informa on
A. Legible signature of author and date signed
What is the me limit mandated by CMS for adding a late entry to the medical record?
A. One Week
B. One Month
C. One Year
D. No me limit
D. No me limit
When should a ABN be signed?
A. Prior to performing a statutorily excluded procedure for a Medicare beneficiary.
,B. Prior to performing a procedure that may be denied due to medical necessity for a Medicare
beneficiary.
C. Prior to submi>ng a claim to Medicaid for a non- service.
D. A?er performing a procedure and finding it is denied.
B. Prior to performing a procedure that may be denied due to medical necessity for a Medicare
beneficiary.
Under a Corporate Integrity Agreement (CIA), how many claims must be randomly selected to
review to determine the financial error rate?
A. 15
B. 50
C. 75
D. 100
B. 50
When using LCDs and CMS program Guidance as a resource for an audit, what should the
auditor keep in mind?
A. QICs are bound by NCDs, LMRPs, and CMS Program guidance, but ALJs and MACs are not.
B. Local carriers and QICs are bound by LCDs and LMRPs
C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs, ALJs, and MACs are
not bound by them.
D. Local Carriers, QICs, ALJs, and MACs are all bound by NCDs and CMS program guidance.
C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs, ALJs, and MACs are
not bound by them.
When repor ng the claims review findings under a CIA audit, the Independent Review
Organiza on (IRO) must provide:
A. A detailed analysis lis ng the pa ent files reviewed and findings and previous audit
disclosures for all services
, B. A detailed report with a narra ve explana on of finding and suppor ng ra onale approved
by the providers aDorney.
C. A detailed report with an analysis and narra ve explana on with findings and suppor ng
ra onale regarding the claim review, including the results of the discovery or full sample.
D. A list of data reviewed and findings in a narra ve form
C. A detailed report with an analysis and narra ve explana on with findings and suppor ng
ra onale regarding the claim review, including the results of the discovery or full sample.
Which statement is most accurate regarding NCCI?
A. NCCI are na onal coding guidelines and must be followed regardless of the insurance carrier.
B. You need to check individual carriers to see if they follow NCCI or if they have their own set of
bundling edits.
C. Each individual carrier will have its own bundling edits and will not use NCCI.
D. NCCI edits are suggested ways to bundle procedure codes, but are not necessary to review
during an audit.
B. You need to check individual carriers to see if they follow NCCI or if they have their own set of
bundling edits.
A provider request you to perform an audit of claims that have been denied payment by XYZ
insurance. Since the physician contracted with XYZ insurance, all claims submiDed that include
the E/M service and EKG interpreta on on the same day have been denied for the EKG
interpreta on. You review the medical record and the EOB and determine the services are
documented and coded correctly. Which of the following items will you need to complete your
audit?
A. Provider contract with XYZ insurance.
B. Provider internal billing polices.
C. RAC statement of work
D. OIG work plan for the current year.
RATED A+ 2026
The Joint Commission (JC) requires the Factors that Affect Learning must be assessed for a
hospital or hospital owned physician prac ce as well as other health care facili es. When
assessing this element what does this include?
A. The pa ent's ability to read, method of learning and understanding.
B. Any language or physical disabili es.
C. Cultural beliefs.
D. All the above
D. All the above
Report copies and printouts, films, scans, and other radio logic service image records must be
retained for how long according to Federal Regula ons?
A. 10 years
B. 7 years
C. 5 years
D. 3 years
C. 5 years
At which point should a provider repay over payments reported by self-disclosure to the office
of Inspector General?
A. Make the payment to your carrier immediately.
B. Make the payment at the conclusion of the OIG injury.
C. Make the payment to the carrier prior to the self disclosure.
D. Make the payment to the OIG with a self disclosure report.
,B. Make the payment at the conclusion of the OIG injury
Which of the following may be considered essen al element (s) of an opera ve report and will
allow for accurate coding?
A. The approach
B. The type of anesthesia required
C. The loca on and severity of wounds repaired
D. All of the above
D. All of the above
Which of the following is NOT a covered en ty under HIPPA?
A. Physician
B. Health Plan
C. Health Care Consultant
D. Physician Assistant
C. Health Care Consultant
When referring to the authen ca on of a medical record entry, what does this entail?
A. Legible signature of author and date signed
B. A physician's order for ancillary services
C. An original document filed in the record
D. The pa ent's personal informa on
A. Legible signature of author and date signed
What is the me limit mandated by CMS for adding a late entry to the medical record?
A. One Week
B. One Month
C. One Year
D. No me limit
D. No me limit
When should a ABN be signed?
A. Prior to performing a statutorily excluded procedure for a Medicare beneficiary.
,B. Prior to performing a procedure that may be denied due to medical necessity for a Medicare
beneficiary.
C. Prior to submi>ng a claim to Medicaid for a non- service.
D. A?er performing a procedure and finding it is denied.
B. Prior to performing a procedure that may be denied due to medical necessity for a Medicare
beneficiary.
Under a Corporate Integrity Agreement (CIA), how many claims must be randomly selected to
review to determine the financial error rate?
A. 15
B. 50
C. 75
D. 100
B. 50
When using LCDs and CMS program Guidance as a resource for an audit, what should the
auditor keep in mind?
A. QICs are bound by NCDs, LMRPs, and CMS Program guidance, but ALJs and MACs are not.
B. Local carriers and QICs are bound by LCDs and LMRPs
C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs, ALJs, and MACs are
not bound by them.
D. Local Carriers, QICs, ALJs, and MACs are all bound by NCDs and CMS program guidance.
C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs, ALJs, and MACs are
not bound by them.
When repor ng the claims review findings under a CIA audit, the Independent Review
Organiza on (IRO) must provide:
A. A detailed analysis lis ng the pa ent files reviewed and findings and previous audit
disclosures for all services
, B. A detailed report with a narra ve explana on of finding and suppor ng ra onale approved
by the providers aDorney.
C. A detailed report with an analysis and narra ve explana on with findings and suppor ng
ra onale regarding the claim review, including the results of the discovery or full sample.
D. A list of data reviewed and findings in a narra ve form
C. A detailed report with an analysis and narra ve explana on with findings and suppor ng
ra onale regarding the claim review, including the results of the discovery or full sample.
Which statement is most accurate regarding NCCI?
A. NCCI are na onal coding guidelines and must be followed regardless of the insurance carrier.
B. You need to check individual carriers to see if they follow NCCI or if they have their own set of
bundling edits.
C. Each individual carrier will have its own bundling edits and will not use NCCI.
D. NCCI edits are suggested ways to bundle procedure codes, but are not necessary to review
during an audit.
B. You need to check individual carriers to see if they follow NCCI or if they have their own set of
bundling edits.
A provider request you to perform an audit of claims that have been denied payment by XYZ
insurance. Since the physician contracted with XYZ insurance, all claims submiDed that include
the E/M service and EKG interpreta on on the same day have been denied for the EKG
interpreta on. You review the medical record and the EOB and determine the services are
documented and coded correctly. Which of the following items will you need to complete your
audit?
A. Provider contract with XYZ insurance.
B. Provider internal billing polices.
C. RAC statement of work
D. OIG work plan for the current year.
