CPMA Study Guide Questions and answers, 100% Accurate. Verified.

CPMA Study Guide Questions and answers, 100% Accurate. Verified. The Joint Commission requires that Factors that Affect Learning must be ascertained for a hospital or hospital owned physician practice when assessing this element what does this include? - -*The patients ability to read, method learning, & understanding. *Any language or physical disabilities *Cultural beliefs. According to Federal regulations how long must report copies and printouts of films, scans, & other radiological image services be kept? - -5 years. At what point would a provider repay overpayments reported on a self-disclosure to the OIG? - -At the conclusion of the OIG inquiry. What is considered essential elements to allow for proper coding of an operative report? - -*the approach *type of anesthesia *location & severity of the wounds repaired. Who is NOT considered a covered entity under HIPAA? - -Health care consultant What entails the proper authentication of an entry in a medical record? - -Legible signature of the author and the date the entry is signed. What is the time limit mandated by CMS for adding a late entry into a medical record? - -There is not a time limit. When should an ABN be signed? - -Prior to performing a procedure that may be denied for lack of medical necessity to a Medicare beneficiary Under a Corporate Integrity Agreement how many charts must be audited to determine the financial error rate? - -50 charts. When using LCD and CMS Program Guidance for a resource for an audit, what should the auditor keep in mind? - -Local carriers follow LCDs, LMRPs, and CMS Guidance Programs but QICs, ALJs, and MACs are not bound by them. When reporting claim review findings under a Corporate Integretity Agreement, and Independent Review organization must provide? - -A detailed report with an analysis & a narrative explanation with findings & supporting rationale regarding the claim review including the results of the discovery or full sample. Accurate statement about NCCI? - -You need to check individual carriers to see if they have their own bundling edits or follow NCCI guidelines. A provider asks you to perform an audit of claims that have been denied payment with XYZ insurance. Since contracting with XYZ all E/M codes filed with EKG interpretation have been denied, but you review & claims are correct. What is next step you would take? - -Look at the provider contract with XYZ to see if this is excluded for payment. What is an example of intentional fraudulent coding scenario? - -Reporting 29881 with 29877-59 when the procedures are performed in different compartments of the right knee. According to the OIG Compliance for Individual & Small Physican Practices the essential elements of a compliance package include? - -Conducting appropriate training & education.