CPMA STUDY QUESTIONS AND ANSWERS

CPMA STUDY QUESTIONS AND ANSWERS WHAT IS THE IMPORTANCE OF AUDIT IN A PRACTICE? - Correct ️️ 1. Reviewing quality of care provided to patients. 2. Educating providers on documentation. 3. Ensuring all services are supported and all appropriate revenue is captured. 4. Defending against external audit malpractice litigation and health plan request and denial. Exclusion Statute - Correct ️️ 1.Physician is banned from participating in any federal or state healthcare program by OIG 2. They can't bill federal or state for any services provided .3 length: host less than five years .4 When exclusionary period has ended dr must apply for reinstatement and receive authorize notice from OIG that reinstate has been granted Abuse - Correct ️️ In action resulting in unnecessary cost to a federal healthcare program either directly or indirectly What is the civil penalty - Correct ️️ Not less than 5000 and not more than 10,000 per claim x3 times the amount of government damages Federal False Claims Act - Correct ️️ Having knowledge that claims is fake. .1 knowing and knowingly that a person must act in deliberate ignorance of the truth or falsely of the relevant information or act in a reckless manner of the truth or falsity of the Information Qui Tam - Correct ️️ whistleblower what percentage is offered for a whistleblower/qui tam as an award from what is recovered by the government? - Correct ️️ between 15% and 25% fraud - Correct ️️ Knowingly making false statements or misrepresenting facts to obtain an undeserved benefit or payment from federal healthcare program Discovery sample - Correct ️️ CIA - 50 samples units randomly selected *determines the net financial error rate .2 if error rate exceeds 5% a full sample must be reviewed HHS OIG 3 core publications - Correct ️️ plan