Cpma Quiz Bank. Top Exam Questions and answers, 100% Accurate, rated A+

Cpma Quiz Bank. Top Exam Questions and answers, 100% Accurate, rated A+ When non-compliance is identified, what does the OIG recommended? a .Take disciplinary action and document the date of the incident, name of the reporting party, name of the person responsible for taking action, and the follow-up action taken. b. Take disciplinary action and document the date of the incident, name of the reporting party, name of the person responsible for taking action,and the follow-up action taken. c. Immediately terminate employment for the party found in non-compliance,regardless of the severity of the offense,document the date of the termination,file a corrected claim on all claims affected. d. Continue to watch the employee in non-compliance until the incidents meet a federal level before taking action. - -b. Take disciplinary action and document the date of the incident, name of the reporting party, name of the person responsible for taking action,and the follow-up action taken A provider consistently charges a higher level E/M service than is documented to help cover the cost of his declining practice. Would this be fraud or abuse Why? a. Abuse,charging one level higher on each visits does not show intent. b. Abuse; the provider's practice is common and therefore would not be considered fraudulent . c. Fraud; and over-coding of services would be considered fraudulent. d. Fraud; the provider intentionally over-coded to gain financially. - -d. Fraud; the provider intentionally over-coded to gain financially. The OIG lists potential risk areas for individual and small physician groups in the compliance plan guidance. Which option below is listed as a risk area? a. Unbundling b. Under Coding c. Overuse of E/M codes d. Failure to follow the "same day" rule - -a. Unbundling The FCA allows for reduced penalties if the person in violation self-discloses if which conditions exist? a. The person furnishes all information about the violation with in 30 days after which the defendant first obtained the information. b. The person fully cooperates with the investigation. c. There is no additional criminal prosecution, civil action, or administrated action with the respect to the violation. d. All of the above - -d. All of the above What is a Qui Tam Relator? a. a person who is prosecuted under FCA. b. The defendant in a Stark Law case. c. a person listed on the OIG exclusions list. d. a person who brings civil action for violation under the FCA for themselves and the government. - -d. a person who brings civil action for violation under the FCA for themselves and the government. What is CoP? a. Medicare Conditions of Participation. b. TriCare's Compliance of Physicians Guidance c. Medicaid's Coordination of Physician Groups d. Commercial Programs - -a. Medicare Conditions of Participation. When a provider is excluded under the Exclusions statute, What must he or she do at the end of the exclusionary period? a. the provider is automatically reinstated b. The provider must apply for reinstatement. c. The provider cannot be reinstated once excluded. d. The provider must apply for a group provider number. - -b. The provider must apply for reinstatement Which option is considered a material breach of CIA? a. Failure to engage and use an IRO in accordance with the CIA. b. Failure to hire an OIG employee to oversee compliance efforts. c. Failure to hire a full-time internal auditor to review every claim before it is submitted. d. Failure to fire auditors who do not agree with the provider's coding - -a. Failure to engage and use an IRO in accordance with the CIA. CMS has two sets of Evaluation and Management Documentations Guidelines , 1995 and 1997. Which set is used by physicians for office visits? a. 1995 E/M Documentation Guidelines b. 1997 E/M Documentation Guidelines c. The practice must choose either the 1995 or 1997 E/M Documentation Guidelines for the entire practice. d. The practice may use 1995 or 1997 E/M Documentation Guidelines for each visit; whichever is most advantageous for that visit. - -d. The practice may use 1995 or 1997 E/M Documentation Guidelines for each visit; whichever is most advantageous for that visit. What is a semi-automated review? a. a review based on electronic data examined form submitted claims . b. A review based on electronic data examined from submitted claims but electively supported by medical records sent by the provider. c. a review based on complete medical records review due lack of Medical Policy being in a place d. a review based on tips sent in from internal informants. - -b. A review based on electronic data examined from submitted claims but electively supported by medical records sent by the provider. Which option is NOT part of the seven elements that should be included in a compliance plan based on the OIG's recommendations? a. Conducting effective training and education. b. Responding promptly to detected offenses and developing corrective action. c. Identifying employees on the exclusions list . d. Developing effective lines of communication - -c. Identifying employees on the exclusions list . What can a provider do if he or she disagrees with a demand letter sent as a result Recovery Audit? a. Submit a discussion period request within 15 days of the date of the demand letter. b. Submit a discussion period request within 120 days of the date of the demand letter. c. Submit a request for review to the MAC within 15 days from the date of the demand letter. d. Submit a request for review to the MAC within 120 days from the date of the demand letter. - -a. Submit a discussion period request within 15 days of the date of the demand letter. A. Qui Tam Relator may receive what type of award for bringing a case on which the government intervenes? a. 10-15 percent of the money recovered b. 15-25 percent of the money recovered c. 10-15 percent of the total claim amount d. 15-25 percent of the total claim amount - -b. 15-25 percent of the money recovered A corporate Integrity Agreement (CIA ) has seven core elements. Which option is NOT one of the core elements? a. Provider an implementation report and annual reports to OIG on the status of the entity's compliance activities. b. Hire an OIG employee to oversee the compliance efforts c. Develop written standards and policies d. Restrict employment of ineligible persons. - -b. Hire an OIG employee to oversee the compliance efforts Recovery auditors may perform three types of reviews. What review requires medical records? a. Automated b. Semi Automated c. Complex d. Independent - -d. Independent In NCCI edits, what does modifier indicator zero represent? a. A modifiers is not allowed to bypass the NCCI edits. b. A modifier may be used to bypass the edits if the documentation supports the modifier. c. Modifiers are not applicable to the edits. d. The NCCI edits is not in effect. - -a. A modifiers is not allowed to bypass the NCCI edits What is one of the differences between the Stark Law and the Anti-Kickback Law? a. No intent must be proven for the Stark law; the Anti-Kickback law requires proof of intention. b. No intent must be proven for the Anti-Kickback law The Stark law requires proof of intention. c. The Stark law refers to fraudulent billing; the Anti-Kickback law refers to remuneration for self referrals. d. The Anti-Kickback law refers to fraudulent billing; the Stark law refers to remuneration for self referrals. - -a. No intent must be proven for the Stark law; the Anti-Kickback law requires proof of intention. What is another name for the Federal False Claims Act? a. Operation Restore Trust b. Kennedy-Kassebaum Law c. Lincoln Law d. Stark Law - -c. Lincoln Law According to this excerpt from the MUE table, which procedure can be reported with more than two units on the same date of service? HCPCS/CPT CODE Practitioner Services MUE Values 15758 3 15760 2 15770 2 15775 1 15776 1 15777 1 15780 1 a. 15758 b. 15770 c. 15776 d. 15780 - -a. 15758 Recovery auditors may perform three types of reviews. What is an automated review? a. Review based solely on the submitted claims and regulatory guidelines. No medical records are needed. b. Review based on data and potential human review of a medical record or other documentation. c. Medical records are required for review d. Review is based solely on denials received. - -a. Review based solely on the submitted claims and regulatory guidelines. No medical records are needed. Which of the following best represents and example of fraudulent activity? a. Waiving cost-shares or deductibles. b. A pattern of claims for services not medically necessary. c. Failure to maintain adequate medical or financial records. d. Billing for services at a higher level than provided or necessary. - -d. Billing for services at a higher level than provided or necessary. What rights does a provider have if he/she disagrees with a demand letter sent by the OIG? a. The provider can choose to self-disclose once a demand letter has been received. b. The provider can send in supporting documentation for the claims to the OIG for review by certified mail. c. The provider can only respond to the demand letter with payment. d. The provider can request a hearing before and ALJ in HHS. - -d. The provider can request a hearing before and ALJ in HHS. When an IRO is completing a CIA Discovery Sample, how many sampling units are reviewed? a. 10 b. 50 c. 100 d. 200 - -b. 50 In the NCCI edits, what does modifier indicator one represent? a. A modifiers is not allowed to bypass the NCCI edits b. A modifier may be used to bypass the edits if the documentation supports the modifier. c. Modifiers are not applicable to the edits. d. The NCCI edit is not in effect. - -b. A modifier may be used to bypass the edits if the documentation supports the modifier. What program is provided by the OIG to assist in random selection of charts for Discovery Sample? a. The OIG provides an on-site investigator to randomly select the charts for the Discovery Sample. b. The OIG provides a statistical sampling program called RAT-STATS. c. The OIG recommends using Excel for statistical sampling. d. The OIG does not have a program to assist in random sampling. - -b. The OIG provides a statistical sampling program called RAT-STATS. The FCA allows for reduced penalties if the person in violation self-disclose s if which conditions exist? a. The person furnishes all information about the violation within 30 days after which the defendant first obtained the information. b. The person fully cooperates with the investigation. c. There is no additional criminal prosecution, civil action, or administrated action with the respect to the violation. d. all of the above - -d. all of the above What does the MUE table indicate? a. When a procedure or service is bundled with another