AAPC CASES CPMA Review – Questions & Solutions
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 Ans -
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 Ans - 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 Ans - 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 Ans - Yes,
chart entry should not be made in advance of the treatment.
Patients can request copies of disclosure of PHI under HIPAA: Correct
Ans - 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 Ans - S in SOAP and C in CHEDDAR
When must ABNs be signed? Correct Ans - 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 Ans - 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 Ans - 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 Ans - 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 Ans - A. Physician tax issues
What are the recommended number of charts to audit per provider and the
minimum frequency of the audit? Correct Ans - C. 10 records per
provider each year
How is RAT-STATS used by an auditor? Correct Ans - B. Software
used in performing statistical random samples and evaluating results
A comprehensive audit is: Correct Ans - 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 Ans - B. OIG
Work Plan
Commercial and Government carriers audit medical records. Select the
statement that is true regarding commercial and government carriers.
Correct Ans - B. Commercial carriers and Government carriers both use
claims data to find locate providers and services to audit.
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 Ans -
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 Ans - 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 Ans - 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 Ans - Yes,
chart entry should not be made in advance of the treatment.
Patients can request copies of disclosure of PHI under HIPAA: Correct
Ans - 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 Ans - S in SOAP and C in CHEDDAR
When must ABNs be signed? Correct Ans - 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 Ans - 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 Ans - 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 Ans - 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 Ans - A. Physician tax issues
What are the recommended number of charts to audit per provider and the
minimum frequency of the audit? Correct Ans - C. 10 records per
provider each year
How is RAT-STATS used by an auditor? Correct Ans - B. Software
used in performing statistical random samples and evaluating results
A comprehensive audit is: Correct Ans - 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 Ans - B. OIG
Work Plan
Commercial and Government carriers audit medical records. Select the
statement that is true regarding commercial and government carriers.
Correct Ans - B. Commercial carriers and Government carriers both use
claims data to find locate providers and services to audit.
