CPMA EXAM chapter 5. Questions and answers, 100% Accurate. Approved.

CPMA EXAM chapter 5. Questions and answers, 100% Accurate. Approved. Which statement is true regarding an audit performed on charts for Medicare beneficiaries? - -National CMS policies and local MAC policies should be utilized when performing Medicare audits. In addition to CMS it is necessary to know your Medicare Administrative Contractor that supports the location where services are rendered for example 4x4 rule. How often should an internal audit be conducted minimally? - -Annually (more often if problem is seen) What is a utilization review? - -A technique that provides data about how frequently certain services are billed. A utilization pattern can be found from looking to evaluate patterns(data mining). What is numerical sampling? - -Sampling based on all possible services within a chosen time frame. In this methodology, the sample size is based on all possible services within a certain timeframe. This type of sample lends itself well to a random final selection. What is considered good parameters for a baseline audit? - -Random audit of 10-15 records per practitioner along with office and surgical procedures selected procedures selected randomly. Which resource is valuable when performing a surgical audit? - -NCCI Manual assists the auditor in determining bundling issues with CPT code services provided. What is non-statistical sampling? - -Sample based on unique services that were defined in the objective and scope and is used in focused audits. It may be considered judmental. Which type of audit often realizes more objectivity than with an employed auditor - -External audit- the advantage is the independence allows for a more objective review than the one who is employed by the practice. When performing a government audit, the NCCI edits manual can serve what purpose? - -Support the use of modifiers and can point out bundling errors when performing the audit. An audit performed prior to claims submission is referred to as what type of audit? - -Prospective audit As an auditor, you work for a CPA firm who has been asked to perform an audit of a new practice to determine risk areas for their documentation. There have not been any prior audits at this practice. What type of audit should be performed? - -Random audit What is an example of how office policies are helpful in an audit? - -Office policies may specify what to bill service and problem visit are provided at the same time. Which list represents the most comprehensive list of items reviewed in a retrospective audit? - -Medical record documentation, encounter form, explanation of benefits or remittance advice, and payer policies. A practice contacts an external auditor and explains the practice is billing incident-to services and is not sure they are documenting appropriately, or following the guidelines. What services would the external audit focus on during an audit based on this information? - -NPP services provided in the practice.- Incident -to referes to services provided by NPPs but reported ubder the supervising physicians's provider number. What is RAT-STATS? - -A statistical sampling software offered by the OIG to assist in claims review. From an audit perspective, consulting the MAC website for guidance regarding medical necessity coverage decision can be an opportunity to see if what form is being used and completed correctly? - -Advanced beneficiary notice(ABN). From an audit prospective ,this is an opportunity to determine if ABN forms have already been submitted for payment and processed by the insurance carrier. An audit performed after the claims have been submitted is referred to as what type of audit? - -Retrospective audit