AAPC CASES CPMA Review Questions
and answers, (Answered). Verified.
You are performing an audit of evaluation and management services for a family practice office. In the
encounter, you read the physician ordered and reviewed a differential WBC. Which of the following best
describes what you would expect to see in the medical record? - ✔✔-Patient identification, assignment
of benefits, patient's medical history, immunizations, physical examination, lab report, clinical
impression, and physician orders.
As an auditor, who of the following would NOT be expected to submit operative notes? - ✔✔-Surgical
assistants
A provider knows that an evaluation and management service they provide on the same date as a major
procedure will be bundled, so he submits the claim for the E/M with a different date of service. This is
an example of: - ✔✔-Fraud
In preparation for a high volume of patients coming in for chemotherapy, the nurse documents the
chemotherapy treatments in advance. The purpose is to speed up the treatment process so patients do
not have to wait long. Would this cause concern in an audit? - ✔✔-Yes, chart entry should not be made
in advance of the treatment.
Patients can request copies of disclosure of PHI under HIPAA: - ✔✔-For a six (6) year period of time
SOAP and CHEDDAR are two formats of medical record documentation. Which section of each format
would you find the patient's history? - ✔✔-S in SOAP and C in CHEDDAR
When must ABNs be signed? - ✔✔-Far enough in advance that the beneficiary or representative has
time to consider the options and make an informed choice
What is the appropriate way to dispose of PHI that is no longer needed? - ✔✔-Discard it in a locked
shredding receptacle
, Which of the following would NOT be expected to fall under the responsibility or oversight of an
organization's compliance committee? - ✔✔-C. Recommending a specific merit increase in pay for
employee's adherence to the code of conduct
A family physician requests a post payment audit on claims from a particular commercial payer from
which he is receiving denials. Whenever the provider performs a minor procedure with an E/M service,
the minor surgery is reimbursed but the E/M service is denied. You review 10 charts and all cases are
documented and coded correctly. What could be the reason for the denial? - ✔✔-The payer contract
may bundle the E/M service when performed on the same day as the minor surgery
Which type of case is not prosecuted under the federal false claims act? - ✔✔-A. Physician tax issues
What are the recommended number of charts to audit per provider and the minimum frequency of the
audit? - ✔✔-C. 10 records per provider each year
How is RAT-STATS used by an auditor? - ✔✔-B. Software used in performing statistical random samples
and evaluating results
A comprehensive audit is: - ✔✔-A. A large number of claims are selected for a review that might be
focused on specific procedure and/or diagnosis codes.
According to the 2017 _________, the OIG will review Medicare Part B payments for prolonged services
to determine whether the payments were made according to Medicare requirements. - ✔✔-B. OIG
Work Plan
Commercial and Government carriers audit medical records. Select the statement that is true regarding
commercial and government carriers. - ✔✔-B. Commercial carriers and Government carriers both use
claims data to find locate providers and services to audit.
A full sample must be reviewed and a systems review must be conducted when the net financial error
rate of the sampling equals or exceeds what percent? - ✔✔-A. 5%
and answers, (Answered). Verified.
You are performing an audit of evaluation and management services for a family practice office. In the
encounter, you read the physician ordered and reviewed a differential WBC. Which of the following best
describes what you would expect to see in the medical record? - ✔✔-Patient identification, assignment
of benefits, patient's medical history, immunizations, physical examination, lab report, clinical
impression, and physician orders.
As an auditor, who of the following would NOT be expected to submit operative notes? - ✔✔-Surgical
assistants
A provider knows that an evaluation and management service they provide on the same date as a major
procedure will be bundled, so he submits the claim for the E/M with a different date of service. This is
an example of: - ✔✔-Fraud
In preparation for a high volume of patients coming in for chemotherapy, the nurse documents the
chemotherapy treatments in advance. The purpose is to speed up the treatment process so patients do
not have to wait long. Would this cause concern in an audit? - ✔✔-Yes, chart entry should not be made
in advance of the treatment.
Patients can request copies of disclosure of PHI under HIPAA: - ✔✔-For a six (6) year period of time
SOAP and CHEDDAR are two formats of medical record documentation. Which section of each format
would you find the patient's history? - ✔✔-S in SOAP and C in CHEDDAR
When must ABNs be signed? - ✔✔-Far enough in advance that the beneficiary or representative has
time to consider the options and make an informed choice
What is the appropriate way to dispose of PHI that is no longer needed? - ✔✔-Discard it in a locked
shredding receptacle
, Which of the following would NOT be expected to fall under the responsibility or oversight of an
organization's compliance committee? - ✔✔-C. Recommending a specific merit increase in pay for
employee's adherence to the code of conduct
A family physician requests a post payment audit on claims from a particular commercial payer from
which he is receiving denials. Whenever the provider performs a minor procedure with an E/M service,
the minor surgery is reimbursed but the E/M service is denied. You review 10 charts and all cases are
documented and coded correctly. What could be the reason for the denial? - ✔✔-The payer contract
may bundle the E/M service when performed on the same day as the minor surgery
Which type of case is not prosecuted under the federal false claims act? - ✔✔-A. Physician tax issues
What are the recommended number of charts to audit per provider and the minimum frequency of the
audit? - ✔✔-C. 10 records per provider each year
How is RAT-STATS used by an auditor? - ✔✔-B. Software used in performing statistical random samples
and evaluating results
A comprehensive audit is: - ✔✔-A. A large number of claims are selected for a review that might be
focused on specific procedure and/or diagnosis codes.
According to the 2017 _________, the OIG will review Medicare Part B payments for prolonged services
to determine whether the payments were made according to Medicare requirements. - ✔✔-B. OIG
Work Plan
Commercial and Government carriers audit medical records. Select the statement that is true regarding
commercial and government carriers. - ✔✔-B. Commercial carriers and Government carriers both use
claims data to find locate providers and services to audit.
A full sample must be reviewed and a systems review must be conducted when the net financial error
rate of the sampling equals or exceeds what percent? - ✔✔-A. 5%
