CPMA STUDY QUESTIONS WITH ACCURATE SOLUTIONS
What is the importance of audit in a practice? Correct Ans - 1.
Reviewing quality of care provided to patients. 2. Educating providers on
documentation. 3. Ensuring all services are supported and all appropriate
revenue is captured. 4. Defending against external audit malpractice
litigation and health plan request and denial.
Exclusion Statute Correct Ans - 1.Physician is banned from
participating in any federal or state healthcare program by OIG 2. They
can't bill federal or state for any services provided .3 length: host less than
five years .4 When exclusionary period has ended dr must apply for
reinstatement and receive authorize notice from OIG that reinstate has
been granted
Abuse Correct Ans - In action resulting in unnecessary cost to a
federal healthcare program either directly or indirectly
What is the civil penalty Correct Ans - Not less than 5000 and not
more than 10,000 per claim x3 times the amount of government damages
Federal False Claims Act Correct Ans - Having knowledge that
claims is fake.
.1 knowing and knowingly that a person must act in deliberate ignorance of
the truth or falsely of the relevant information or act in a reckless manner
of the truth or falsity of the Information
Qui Tam Correct Ans - whistleblower
what percentage is offered for a whistleblower/qui tam as an award from
what is recovered by the government? Correct Ans - between 15%
and 25%
fraud Correct Ans - Knowingly making false statements or
misrepresenting facts to obtain an undeserved benefit or payment from
federal healthcare program
, Discovery sample Correct Ans - CIA - 50 samples units randomly
selected *determines the net financial error rate .2 if error rate exceeds 5%
a full sample must be reviewed
HHS OIG 3 core publications Correct Ans - 1.work plan
2.semiannual report to congress
3. compendium unimplemented recommendation
non-compliant conduct must be documented in compliance files & should
include Correct Ans - 1. date of incident
2.name of the reporting party
3.name of the person responsible for taking action
4.the follow up the action taken
What is an auditor Correct Ans - Reviews healthcare providers
policies add procedures to ensure compliance with applicable
requirements
cms uses what avenues to deliver Information Correct Ans -
1.webcasts
2. transmitting
3.manuals
4.the medicare learning network
CIA
Corporate Integrity Agreement Correct Ans - Last five years can be
longer if OIG likes OIG will require CIA as a condition for not seeking
exclusion from participation when they seek to settle civil fraud cases
requirements hearing compliance officer/ appointments compliance
committee , employee training program,IRO
(IRO) independent review organization Correct Ans - (Third-party
medical review resource) 1. Provides objective unbiased audits and
reports. 2. OIG can notify provider within 30 days if IRO is unacceptable
and may request IRO be terminated and another IRO be retained.
Civil Monetary Penalties Law (CMP) Correct Ans - (Improper filing
of claims- Upcoding, miscoding) 1. Knowing it's a false claim. 2. Knowing
Dr. is not licensed. 3. Changing DOS to when PT was effective with a
What is the importance of audit in a practice? Correct Ans - 1.
Reviewing quality of care provided to patients. 2. Educating providers on
documentation. 3. Ensuring all services are supported and all appropriate
revenue is captured. 4. Defending against external audit malpractice
litigation and health plan request and denial.
Exclusion Statute Correct Ans - 1.Physician is banned from
participating in any federal or state healthcare program by OIG 2. They
can't bill federal or state for any services provided .3 length: host less than
five years .4 When exclusionary period has ended dr must apply for
reinstatement and receive authorize notice from OIG that reinstate has
been granted
Abuse Correct Ans - In action resulting in unnecessary cost to a
federal healthcare program either directly or indirectly
What is the civil penalty Correct Ans - Not less than 5000 and not
more than 10,000 per claim x3 times the amount of government damages
Federal False Claims Act Correct Ans - Having knowledge that
claims is fake.
.1 knowing and knowingly that a person must act in deliberate ignorance of
the truth or falsely of the relevant information or act in a reckless manner
of the truth or falsity of the Information
Qui Tam Correct Ans - whistleblower
what percentage is offered for a whistleblower/qui tam as an award from
what is recovered by the government? Correct Ans - between 15%
and 25%
fraud Correct Ans - Knowingly making false statements or
misrepresenting facts to obtain an undeserved benefit or payment from
federal healthcare program
, Discovery sample Correct Ans - CIA - 50 samples units randomly
selected *determines the net financial error rate .2 if error rate exceeds 5%
a full sample must be reviewed
HHS OIG 3 core publications Correct Ans - 1.work plan
2.semiannual report to congress
3. compendium unimplemented recommendation
non-compliant conduct must be documented in compliance files & should
include Correct Ans - 1. date of incident
2.name of the reporting party
3.name of the person responsible for taking action
4.the follow up the action taken
What is an auditor Correct Ans - Reviews healthcare providers
policies add procedures to ensure compliance with applicable
requirements
cms uses what avenues to deliver Information Correct Ans -
1.webcasts
2. transmitting
3.manuals
4.the medicare learning network
CIA
Corporate Integrity Agreement Correct Ans - Last five years can be
longer if OIG likes OIG will require CIA as a condition for not seeking
exclusion from participation when they seek to settle civil fraud cases
requirements hearing compliance officer/ appointments compliance
committee , employee training program,IRO
(IRO) independent review organization Correct Ans - (Third-party
medical review resource) 1. Provides objective unbiased audits and
reports. 2. OIG can notify provider within 30 days if IRO is unacceptable
and may request IRO be terminated and another IRO be retained.
Civil Monetary Penalties Law (CMP) Correct Ans - (Improper filing
of claims- Upcoding, miscoding) 1. Knowing it's a false claim. 2. Knowing
Dr. is not licensed. 3. Changing DOS to when PT was effective with a
