CPMA Exam Questions and answers, 100% Accurate, graded A+

CPMA Exam Questions and answers, 100% Accurate, graded A+ Fraud or Abuse: Billing for a service at a higher level than provided - -Fraud What is a Qua Tam relator? - -A person who brings a civil action for a violation for him/herself & for US Govt What is the difference between Stark Law & Antikickback law? - -No INTENT must be provien for Stark, Antikickpack requires proof of intent When banned for Fed/State healthcare program, what is the term of exclusion (in Years)? - -5 years How often are the OIG workplans updated? - -Monthly online The FCA allows for reduced penalties if the person committing the violation does what? - -Self discloses Fraud or Abuse? Misrepresenting a DX to justify payment? - -Fraud Fraud or Abus? Improper billing practices - -Abuse Fraud or Abuse? Altering claim forms and/or receipts to receive a higher payment amount. - -Fraud Fraud or Abuse? Billing Medicare patients a higher fee schedule compared to non-Medicare patients. - -Abuse What does FCA stand for? - -Federal False Claims Act How else is the Start Law referred? - -Physician self-referral law How many federal OIGs are there? - -73 What is the CIA? - -Corporate Integrity Agreements lasting typically 5 years as a guideline to help providers that have been excluded. When CIAs require claim reviews what is considered the DISCOVERY sample? - -50 claims randomly selected (95% accuracy required) What are the fundamental elements for an effective compliance program? - -1. Written policies 2. Compliance officer/committee 3. Training/education 4. Communication 5.Enforcement of standars & disciplinary actions 6. Internal audtis 7. respond & develope corrective action plan In a Corporate Integrity Agreement (CIA) does the OIG specify the IRO to be used? - -NO, but the OIG does retain the right to notify the provider if they must select a new IRO When non-compliance is identified, what does the OIG suggest? - -Take disciplinary action & document the date of the incident, the name of the reporting party, name of the person responsible for taking action and the f/u action taken. The OIG lists potential risks for individual/small group practices compliance plans. Name a potential risk area - -UNBUNDLING What are the three key components of E&M? - -HX, Exam & MDM If there is an issue of GAIT determined in the patient's exam, how could that be counted in the EXAM depending on the patient's condition? - -Neurology or M/S What are the CCI indicators - -0 NOT ALLOWED 1 Allowed with supporting documentation 9 DOES NOT Apply What is MUE? - -Medically Unlikely Edits that define the max units of service that a provider can report for a patient on the same DOS What can a provider do if he/she disagrees with a RAC Letter? - -He/She may submit a dicussion period to the RAC w/in 30 days from the date of the demand letter. Which modifier INDICATOR allows the modifier to be appended to bypass the NCCI? - -1 with supporting documentation If a provider requires his staff to intentionally code E&M services one level higher than what is documented, is this Fraud or Abuse? - -Abuse What does HIPAA mean? - -Health Insurance Portability and Accountability Act The privacy rule requires what? - -A covered entity must disclose protected health info to an individual upon request or HHS when it is investigating. What department is responsible for the criminal prosecutions under the Privacy Rule? - -DOJ What is an example of info that may be transmitted electronically and covered under the privacy rule? - -Claim form/1500 Is IU a valid abbreviation for international unit? - -No; it could be misunderstood as IV. Instead the info should state "International Unit." True or false: Any findings that are abnormal must have elaborations as to indicate the abnormality for the patient. - -TRUE What is the CoP for hospital records retention? - -Five years after the closed cost report When there is an absence of clearly defined laws and regulations relating to the content of a medical record what should the healthcare entity do? - -Establish their own standards Is a rubber stamp an acceptable form for signature - -