CPMA Questions And Answers
Which may result in false claims act violation?
A. A provider routinely waives the copay for MCR beneficiaries
B. A provider accepts insurance only payments from MCR beneficiaries
C. A provider submits claims to MCR for DME supplies not provided to MCR beneficiaries
D. A provider knowingly submits claims to MCR for DME supplies not provided MCR
beneficiaries D. A provider knowingly submits claims to MCR for DME supplies not
provided MCR beneficiaries
A Qui Tam Relator may receive what type of award for bringing a case in which the government
intervenes?
A. 15-25% of money recovered
B. 10-15% of money recovered
C. 10-15% of total claim amount
D. 15-40% of total claim amount A. 15-25% of money recovered
What is the look back period for FFS Recovery Auditors reviewing claims?
A. 60 days
B. 5 years
, CPMA Questions And Answers
C. 15 year
D. 3 years D. 3 years
The OIG lists potential risk areas for physician groups in the compliance plan guidance. Which
option is listed as a risk area?
A. Under Coding
B. Unbundling
C. Overuse of E/M Codes
D. Failure to follow the same-day rule B. Unbundling
In the NCCI edits, what does modifier indicator zero (0) represent?
A. Modifiers are not applicable to the edits
B. The NCCI edit is not in effect
C. A modifier may not be used to bypass the edits if the documentation supports the modifier
D. A modifier is not allowed to bypass the NCCI edits D. A modifier is not allowed to
bypass the NCCI edits
What can a provider do if he or she disagrees with a demand letter sent as a result of a recovery
audit?
, CPMA Questions And Answers
A. Submit a request for review to the MAC within 120 days from the date of the demand letter
B. Submit a request for review to the MAC within 15 days from the date of the demand letter
C. Submit a discussion period request within 120 days of the date of the demand letter
D. Submit a discussion period request within 30 days of the date of the demand letter D.
Submit a discussion period request within 30 days of the date of the demand letter
Which of the following best represents an example of fraud?
A. Billing for services at a higher level than provided or necessary
B. Waiving cost-shares or deductibles
C. A pattern of claims for services not medically necessary
D. Failure to maintain adequate medical or financial records A. Billing for services at a
higher level than provided or necessary
When a physician is banned from participating in any Federal or State health care program by the
OIG under the Exclusion Statue, what is the minimum term of exclusion applies?
A. 10 years
B. 5 Years
C. 60 Days
D. 1 year B. 5 Years
, CPMA Questions And Answers
Which of the following actions is an example of fraud or misconduct subject to the False Claims
act?
A. The provider receives a lab result back and documents in the patient's chart that the lab result
indicates a malignant lesion
B. The provider alters all medical records for lesion excisions to support the level he reported on
the claim
C. The provider determines he has forgotten to document the size of the one lesion and makes an
addendum
D. The provider reviews his records and determines the documentation supports the calims.
B. The provider alters all medical records for lesion excisions to support the level he
reported on the claim
You Audit provider who is consistently reporting multiple units of CPT code 11042. What
references can you use to show the provider multiple units of CPT code 11042 is not allowed and
explain how it should be reported ?
a. CPT codebook and MUE table.
b. CPT codebook and NCCI edits
Which may result in false claims act violation?
A. A provider routinely waives the copay for MCR beneficiaries
B. A provider accepts insurance only payments from MCR beneficiaries
C. A provider submits claims to MCR for DME supplies not provided to MCR beneficiaries
D. A provider knowingly submits claims to MCR for DME supplies not provided MCR
beneficiaries D. A provider knowingly submits claims to MCR for DME supplies not
provided MCR beneficiaries
A Qui Tam Relator may receive what type of award for bringing a case in which the government
intervenes?
A. 15-25% of money recovered
B. 10-15% of money recovered
C. 10-15% of total claim amount
D. 15-40% of total claim amount A. 15-25% of money recovered
What is the look back period for FFS Recovery Auditors reviewing claims?
A. 60 days
B. 5 years
, CPMA Questions And Answers
C. 15 year
D. 3 years D. 3 years
The OIG lists potential risk areas for physician groups in the compliance plan guidance. Which
option is listed as a risk area?
A. Under Coding
B. Unbundling
C. Overuse of E/M Codes
D. Failure to follow the same-day rule B. Unbundling
In the NCCI edits, what does modifier indicator zero (0) represent?
A. Modifiers are not applicable to the edits
B. The NCCI edit is not in effect
C. A modifier may not be used to bypass the edits if the documentation supports the modifier
D. A modifier is not allowed to bypass the NCCI edits D. A modifier is not allowed to
bypass the NCCI edits
What can a provider do if he or she disagrees with a demand letter sent as a result of a recovery
audit?
, CPMA Questions And Answers
A. Submit a request for review to the MAC within 120 days from the date of the demand letter
B. Submit a request for review to the MAC within 15 days from the date of the demand letter
C. Submit a discussion period request within 120 days of the date of the demand letter
D. Submit a discussion period request within 30 days of the date of the demand letter D.
Submit a discussion period request within 30 days of the date of the demand letter
Which of the following best represents an example of fraud?
A. Billing for services at a higher level than provided or necessary
B. Waiving cost-shares or deductibles
C. A pattern of claims for services not medically necessary
D. Failure to maintain adequate medical or financial records A. Billing for services at a
higher level than provided or necessary
When a physician is banned from participating in any Federal or State health care program by the
OIG under the Exclusion Statue, what is the minimum term of exclusion applies?
A. 10 years
B. 5 Years
C. 60 Days
D. 1 year B. 5 Years
, CPMA Questions And Answers
Which of the following actions is an example of fraud or misconduct subject to the False Claims
act?
A. The provider receives a lab result back and documents in the patient's chart that the lab result
indicates a malignant lesion
B. The provider alters all medical records for lesion excisions to support the level he reported on
the claim
C. The provider determines he has forgotten to document the size of the one lesion and makes an
addendum
D. The provider reviews his records and determines the documentation supports the calims.
B. The provider alters all medical records for lesion excisions to support the level he
reported on the claim
You Audit provider who is consistently reporting multiple units of CPT code 11042. What
references can you use to show the provider multiple units of CPT code 11042 is not allowed and
explain how it should be reported ?
a. CPT codebook and MUE table.
b. CPT codebook and NCCI edits
