AAPC CASES CPMA Review questions and answers well illustrated.

AAPC CASES CPMA Review questions and answers well illustrated. You are performing an audit of evaluation and management services for a family practice office. In the encounter, you read the physician ordered and reviewed a differential WBC. Which of the following best describes what you would expect to see in the medical record? - correct answers.Patient identification, assignment of benefits, patient's medical history, immunizations, physical examination, lab report, clinical impression, and physician orders. As an auditor, who of the following would NOT be expected to submit operative notes? - correct answers.Surgical assistants A provider knows that an evaluation and management service they provide on the same date as a major procedure will be bundled, so he submits the claim for the E/M with a different date of service. This is an example of: - correct answers.Fraud In preparation for a high volume of patients coming in for chemotherapy, the nurse documents the chemotherapy treatments in advance. The purpose is to speed up the treatment process so patients do not have to wait long. Would this cause concern in an audit? - correct answers.Yes, chart entry should not be made in advance of the treatment. Patients can request copies of disclosure of PHI under HIPAA: - correct answers.For a six (6) year period of time SOAP and CHEDDAR are two formats of medical record documentation. Which section of each format would you find the patient's history? - correct answers.S in SOAP and C in CHEDDAR When must ABNs be signed? - correct answers.Far enough in advance that the beneficiary or representative has time to consider the options and make an informed choice What is the appropriate way to dispose of PHI that is no longer needed? - correct answers.Discard it in a locked shredding receptacle Which of the following would NOT be expected to fall under the responsibility or oversight of an organization's compliance committee? - correct answers.C. Recommending a specific merit increase in pay for employee's adherence to the code of conduct A family physician requests a post payment audit on claims from a particular commercial payer from which he is receiving denials. Whenever the provider performs a minor procedure with an E/M service, the minor surgery is reimbursed but the E/M service is denied. You review 10 charts and all cases are documented and coded correctly. What could be the reason for the denial? - correct answers.The payer contract may bundle the E/M service when performed on the same day as the minor surgery Which type of case is not prosecuted under the federal false claims act? - correct answers.A. Physician tax issues What are the recommended number of charts to audit per provider and the minimum frequency of the audit? - correct answers.C. 10 records per provider each year How is RAT-STATS used by an auditor? - correct answers.B. Software used in performing statistical random samples and evaluating results A comprehensive audit is: - correct answers.A. A large number of claims are selected for a review that might be focused on specific procedure and/or diagnosis codes. According to the 2017 _________, the OIG will review Medicare Part B payments for prolonged services to determine whether the payments were made according to Medicare requirements. - correct answers.B. OIG Work Plan Commercial and Government carriers audit medical records. Select the statement that is true regarding commercial and government carriers. - correct answers.B. Commercial carriers and Government carriers both use claims data to find locate providers and services to audit. A full sample must be reviewed and a systems review must be conducted when the net financial error rate of the sampling equals or exceeds what percent? - correct answers.A. 5% Which of the following code combinations is an example of unbundling? - correct answers.D. 14000, 11401 Using the NCCI information provided, which of the following statements is TRUE? - correct answers.C. Modifier 59 is not appropriate when billing 60225 and 64530 regardless of the documentation provided. The Stark Statute applies to: - correct answers.C. Only physicians who refer Medicare and Medicaid patients to entities for designated health care services with which the provider or immediate family member has a financial relationship Which of the following scenarios qualifies for the use of modifier 25? - correct answers.Patient presents for a scheduled lesion removal from her right upper arm. She informs her dermatologist that she is starting to notice dry patchy areas on her arms that were not there before. She states that the patches are itchy and sometimes burn. Based on the patient's symptoms and findings upon exam, the provider diagnoses the patient with psoriasis and prescribes a topical corticosteroid. The physician performs the scheduled lesion removal and sends the specimen to pathology. The patient will return in two weeks to discuss the results. Which of the following illustrates an appropriate use of modifier 24? - correct answers.A physician admits a patient to a skilled nursing facility during a global period for a condition that is unrelated to that for which the patient required surgery. The --Modifier 24 modifier is appended to the SNF E/M service code. An infectious disease provider has been notified by the MAC (Medicare Administrative Contractor) in his region that the data indicates he is billing level 99214 more frequent than other providers in the same specialty and geographic region. The provider requests you audit a sample of his claims that were coded as 99214 to determine if he is coding appropriately. What supporting references will you need to conduct the audit? - correct answers.C. 1995 and 1997 CMS Documentation Guidelines When can a RAC extrapolate the overpayment(s) on claims? - correct answers.C. If a RAC can demonstrate a high level of error, the RAC can then extrapolate the findings and request a refund.