CPMA Exam Questions And Answers
The HIPAA Privacy Rule defines "minimum necessary" as typically requiring healthcare
employees to: Follow policies and procedures developed by the covered entity which limit
use and disclosure of PHI to that which is needed to accomplish the intended purpose to perform
the duties of their job.
State law will take precedence over HIPAA under which of the following circumstances:
If HIPAA is less restrictive than state law
When providing a prescription for a patient, the education of the patient (including side effects
and supporting documentation) in the medical record that the information was reviewed is based
on which of the following standards? Joint Commission standards
A deliberate misrepresentation of facts to gain unauthorized benefits is the definition of:
Fraud
What is an action resulting in unnecessary costs, whether directly or indirectly, to a federal
healthcare plan considered? Abuse
, CPMA Exam Questions And Answers
When responding to a subpoena for medical records, which of the following documents would
likely NOT be required to be copied and submitted: Signed authorization for release of
information
Dr. Black receives a demand letter from the OIG stating the sanctions are sought under CMP for
claims submitted by Dr. Black. He asks you, his auditor, to review the letter and the claims that
are under scrutiny. It is determined that Dr. Black should not agree with the demand letter. You
recommend that Dr. Black: Request a hearing before an HHS administrative court judge
An effective compliance plan attributes to: -Better informed employees
-Reduced risk of criminal sanctions, or civil penalties
-Effective operations and increased compliance with both federal and state laws
X-ray A chest X-ray is taken in the office, interpreted by the provider, and provider bills a CPT®
code for the chest X-ray. How is this reported for E/M MDM element Amount and/or
Complexity of Data to be Be Reviewed and Analyzed? None - The billing of the chest X-
ray includes the order of the chest
Billing these two codes together is an examples of unbundling 92025, 65730
, CPMA Exam Questions And Answers
A chest X-ray taken in the ED. The ED physician interprets the X-ray and bills the CPT®
radiology code with ________________. The ED physician is not employed by the hospital.
modifier 26
Which statement is TRUE regarding appending modifier 78 to a claim for a service provided to a
Medicare beneficiary? When modifier 78 is appended, only the intraoperative percentage
is paid and no new global period begins
Which scenario supports medical necessity for critical care services? Care given to a
patient in renal and respiratory failure.
A GI physician begins a diagnostic endoscopy. The physician identifies some concerning lesions
and makes the decision to perform an open procedure the following week. Can both procedures
be reported and if so, what modifier should be appended? Yes, report both procedures
with modifier 58
You are auditing a neurosurgeon's surgical procedures. The documentation for a procedure on
6/3/20XX indicated that the neurosurgeon removed a vagus nerve neurostimulator electrode
array and the pulse generator, replacing both during the same session. How should this procedure
be reported? 64569, 61885-51
The HIPAA Privacy Rule defines "minimum necessary" as typically requiring healthcare
employees to: Follow policies and procedures developed by the covered entity which limit
use and disclosure of PHI to that which is needed to accomplish the intended purpose to perform
the duties of their job.
State law will take precedence over HIPAA under which of the following circumstances:
If HIPAA is less restrictive than state law
When providing a prescription for a patient, the education of the patient (including side effects
and supporting documentation) in the medical record that the information was reviewed is based
on which of the following standards? Joint Commission standards
A deliberate misrepresentation of facts to gain unauthorized benefits is the definition of:
Fraud
What is an action resulting in unnecessary costs, whether directly or indirectly, to a federal
healthcare plan considered? Abuse
, CPMA Exam Questions And Answers
When responding to a subpoena for medical records, which of the following documents would
likely NOT be required to be copied and submitted: Signed authorization for release of
information
Dr. Black receives a demand letter from the OIG stating the sanctions are sought under CMP for
claims submitted by Dr. Black. He asks you, his auditor, to review the letter and the claims that
are under scrutiny. It is determined that Dr. Black should not agree with the demand letter. You
recommend that Dr. Black: Request a hearing before an HHS administrative court judge
An effective compliance plan attributes to: -Better informed employees
-Reduced risk of criminal sanctions, or civil penalties
-Effective operations and increased compliance with both federal and state laws
X-ray A chest X-ray is taken in the office, interpreted by the provider, and provider bills a CPT®
code for the chest X-ray. How is this reported for E/M MDM element Amount and/or
Complexity of Data to be Be Reviewed and Analyzed? None - The billing of the chest X-
ray includes the order of the chest
Billing these two codes together is an examples of unbundling 92025, 65730
, CPMA Exam Questions And Answers
A chest X-ray taken in the ED. The ED physician interprets the X-ray and bills the CPT®
radiology code with ________________. The ED physician is not employed by the hospital.
modifier 26
Which statement is TRUE regarding appending modifier 78 to a claim for a service provided to a
Medicare beneficiary? When modifier 78 is appended, only the intraoperative percentage
is paid and no new global period begins
Which scenario supports medical necessity for critical care services? Care given to a
patient in renal and respiratory failure.
A GI physician begins a diagnostic endoscopy. The physician identifies some concerning lesions
and makes the decision to perform an open procedure the following week. Can both procedures
be reported and if so, what modifier should be appended? Yes, report both procedures
with modifier 58
You are auditing a neurosurgeon's surgical procedures. The documentation for a procedure on
6/3/20XX indicated that the neurosurgeon removed a vagus nerve neurostimulator electrode
array and the pulse generator, replacing both during the same session. How should this procedure
be reported? 64569, 61885-51
