CPMA- CHAPTER ONE EXAM
QUESTIONS WITH CORRECT
ANSWERS
In sthe sNCCI sedits, swhat sdoes smodifier sindicator snine s(9) srepresent?
A smodifier smay sbe sused sto sbypass sthe sedits sif sthe sdocumentation ssupports sthe
smodifier.
B. sA smodifier sis snot sallowed sto sbypass sthe sNCCI sedits.
C. sOnly smodifier s59 scan sbe sused sto sbypass sthe sedit.
D. sModifiers sare snot sapplicable sto sthe sedits, sthe sNCCI sedit sis snot sin seffect. s- sans--D.
sModifiers sare snot sapplicable sto sthe sedits, sthe sNCCI sedit sis snot sin seffect.
Rationale: sThe sCorrect sCoding sfile sformats scontinue sto sinclude sa sCorrect sCoding
sModifier s(CCM) sindicator s(carrier sonly) sfor sboth sthe sComprehensive/Component
sTable. sThis sindicator sdetermines swhether sa sCCM scauses sthe scode spair sto sbypass sthe
sedit. sThis sindicator swill sbe seither s"0," s"1," sor s"9." sThe sdefinitions sof seach sare:
0 s= sA sCCM sis snot sallowed sand swill snot sbypass sthe sedits.
1 s= sA sCCM sis sallowed sand swill sbypass sthe sedits.
9 s= sThe suse sof smodifiers sis snot sspecified. sThis sindicator sis sused sfor sall scode spairs
sthat shave sa sdeletion sdate sthat sis sthe ssame sas sthe seffective sdate. sThis sindicator swas
screated sso sthat sno sblank sspaces swould sbe sin sthe sindicator sfield.
A sprovider sconsistently scharges sa shigher slevel sof sE/M sservice sthan sis sdocumented sto
shelp scover sthe scost sof shis sdeclining spractice. sWould sthis sbe sfraud sor sabuse, sand
swhy?
a. sAbuse; sthe sprovider's spractice sis scommon sand stherefore swould snot sbe sconsidered
sfraudulent.
b. sAbuse; scharging sone slevel shigher son seach svisit sdoes snot sshow sintent.
c. sFraud; sthe sprovider sintentionally sover-coded sto sgain sfinancially.
d. sFraud; sany sover-coding sof sservices swould sbe sconsidered sfraudulent. s- sans--C.
sFraud; sthe sprovider sintentionally sover-coded sto sgain sfinancially.
Response sFeedback: sRationale: sThe sdifference sbetween sfraud sand sabuse sis sintent.
, Based son sthe scompliance sprogram sguidance sdocuments sby sthe sOIG, swhat sshould sbe
sdocumented swhen snon-compliant sconduct sis sfound?
A. sAction sfound sto sbe snon-compliant, sdate sthe semployee's sname swas sreported sto sthe
sOIG.
b. sDate sof sthe sincident, sdate sof stermination sof sthe semployee sin snon-compliance.
c. sDate sof sincident, sname sof sthe sreporting sparty, sname sof sthe sperson sresponsible sfor
staking saction, sfollow-up saction staken.
d. sDate sof sthe sincident, sdate sthe sOIG sreceived sthe sreport son sthe sinvestigation. s- sans--
c. sDate sof sincident, sname sof sthe sreporting sparty, sname sof sthe sperson sresponsible sfor
staking saction, sfollow-up saction staken.
Rationale: sThe sStark slaw shas sstrict sliability sregarding soverpayments, smeaning sno
sintent smust sbe sproven. sFor scivil smonetary spenalties sfor sthe sStark slaw, sthough, sintent
sis srequired sfor sknowing sviolations. sThe sAnti-Kickback slaw srequires sproof sof sintention.
sThe slaw sstates sthe sperson smust s"knowingly sand swillfully" sviolate sthe slaw. sThe s"willful"
sverbiage sis snot sfound sin sthe sStark slaw.
Under sa sCIA, s50 ssampling sunits sare sselected sfor sreview. sWhat sis sthis ssample sreferred
sto sas? s
a. sDiscovery ssample
b. sSelective ssample
c. sComplete ssample
d. sInitial ssample s- sans--a. sDiscovery ssample
Rationale: sUnder sa sCIA, sa sDiscovery sSample sof s50 ssampling sunits sis srandomly
sselected sfor sreview. sThis sDiscovery sSample sis sused sto sdetermine sthe snet sfinancial
serror srate.
The sOIG's sCompliance sProgram sGuidance sfor sIndividual sand sSmall sPhysician sGroup
sPractices sidentifies sfour srisk sareas saffecting sphysician spractices. sWhat sare sthe sfour
srisk sareas?
a. sCoding sand sbilling; sreasonable sand snecessary sservices; sdocumentation; sand
simproper sinducements, skickbacks, sand sself-referrals.
b. sClaims ssubmission; sbackground schecks sfor sstaff; sHIPAA sviolations; saudit
scompliance.
QUESTIONS WITH CORRECT
ANSWERS
In sthe sNCCI sedits, swhat sdoes smodifier sindicator snine s(9) srepresent?
A smodifier smay sbe sused sto sbypass sthe sedits sif sthe sdocumentation ssupports sthe
smodifier.
B. sA smodifier sis snot sallowed sto sbypass sthe sNCCI sedits.
C. sOnly smodifier s59 scan sbe sused sto sbypass sthe sedit.
D. sModifiers sare snot sapplicable sto sthe sedits, sthe sNCCI sedit sis snot sin seffect. s- sans--D.
sModifiers sare snot sapplicable sto sthe sedits, sthe sNCCI sedit sis snot sin seffect.
Rationale: sThe sCorrect sCoding sfile sformats scontinue sto sinclude sa sCorrect sCoding
sModifier s(CCM) sindicator s(carrier sonly) sfor sboth sthe sComprehensive/Component
sTable. sThis sindicator sdetermines swhether sa sCCM scauses sthe scode spair sto sbypass sthe
sedit. sThis sindicator swill sbe seither s"0," s"1," sor s"9." sThe sdefinitions sof seach sare:
0 s= sA sCCM sis snot sallowed sand swill snot sbypass sthe sedits.
1 s= sA sCCM sis sallowed sand swill sbypass sthe sedits.
9 s= sThe suse sof smodifiers sis snot sspecified. sThis sindicator sis sused sfor sall scode spairs
sthat shave sa sdeletion sdate sthat sis sthe ssame sas sthe seffective sdate. sThis sindicator swas
screated sso sthat sno sblank sspaces swould sbe sin sthe sindicator sfield.
A sprovider sconsistently scharges sa shigher slevel sof sE/M sservice sthan sis sdocumented sto
shelp scover sthe scost sof shis sdeclining spractice. sWould sthis sbe sfraud sor sabuse, sand
swhy?
a. sAbuse; sthe sprovider's spractice sis scommon sand stherefore swould snot sbe sconsidered
sfraudulent.
b. sAbuse; scharging sone slevel shigher son seach svisit sdoes snot sshow sintent.
c. sFraud; sthe sprovider sintentionally sover-coded sto sgain sfinancially.
d. sFraud; sany sover-coding sof sservices swould sbe sconsidered sfraudulent. s- sans--C.
sFraud; sthe sprovider sintentionally sover-coded sto sgain sfinancially.
Response sFeedback: sRationale: sThe sdifference sbetween sfraud sand sabuse sis sintent.
, Based son sthe scompliance sprogram sguidance sdocuments sby sthe sOIG, swhat sshould sbe
sdocumented swhen snon-compliant sconduct sis sfound?
A. sAction sfound sto sbe snon-compliant, sdate sthe semployee's sname swas sreported sto sthe
sOIG.
b. sDate sof sthe sincident, sdate sof stermination sof sthe semployee sin snon-compliance.
c. sDate sof sincident, sname sof sthe sreporting sparty, sname sof sthe sperson sresponsible sfor
staking saction, sfollow-up saction staken.
d. sDate sof sthe sincident, sdate sthe sOIG sreceived sthe sreport son sthe sinvestigation. s- sans--
c. sDate sof sincident, sname sof sthe sreporting sparty, sname sof sthe sperson sresponsible sfor
staking saction, sfollow-up saction staken.
Rationale: sThe sStark slaw shas sstrict sliability sregarding soverpayments, smeaning sno
sintent smust sbe sproven. sFor scivil smonetary spenalties sfor sthe sStark slaw, sthough, sintent
sis srequired sfor sknowing sviolations. sThe sAnti-Kickback slaw srequires sproof sof sintention.
sThe slaw sstates sthe sperson smust s"knowingly sand swillfully" sviolate sthe slaw. sThe s"willful"
sverbiage sis snot sfound sin sthe sStark slaw.
Under sa sCIA, s50 ssampling sunits sare sselected sfor sreview. sWhat sis sthis ssample sreferred
sto sas? s
a. sDiscovery ssample
b. sSelective ssample
c. sComplete ssample
d. sInitial ssample s- sans--a. sDiscovery ssample
Rationale: sUnder sa sCIA, sa sDiscovery sSample sof s50 ssampling sunits sis srandomly
sselected sfor sreview. sThis sDiscovery sSample sis sused sto sdetermine sthe snet sfinancial
serror srate.
The sOIG's sCompliance sProgram sGuidance sfor sIndividual sand sSmall sPhysician sGroup
sPractices sidentifies sfour srisk sareas saffecting sphysician spractices. sWhat sare sthe sfour
srisk sareas?
a. sCoding sand sbilling; sreasonable sand snecessary sservices; sdocumentation; sand
simproper sinducements, skickbacks, sand sself-referrals.
b. sClaims ssubmission; sbackground schecks sfor sstaff; sHIPAA sviolations; saudit
scompliance.
