CPMA EXAM chapter 5| 25 Questions| Correct Answers.

Which statement is true regarding an audit performed on charts for Medicare beneficiaries? - ANSWER National CMS policies and local MAC policies should be utilized when performing Medicare audits. In addition to CMS it is necessary to know your Medicare Administrative Contractor that supports the location where services are rendered for example 4x4 rule. How often should an internal audit be conducted minimally? - ANSWER Annually (more often if problem is seen) What is a utilization review? - ANSWER A technique that provides data about how frequently certain services are billed. A utilization pattern can be found from looking to evaluate patterns(data mining). What is numerical sampling? - ANSWER Sampling based on all possible services within a chosen time frame. In this methodology, the sample size is based on all possible services within a certain timeframe. This type of sample lends itself well to a random final selection. What is considered good parameters for a baseline audit? - ANSWER Random audit of 10-15 records per practitioner along with office and surgical procedures selected procedures selected randomly. Which resource is valuable when performing a surgical audit? - ANSWER NCCI Manual assists the auditor in determining bundling issues with CPT code services provided. What is non-statistical sampling? - ANSWER Sample based on unique services that were defined in the objective and scope and is used in focused audits. It may be considered judmental. Which type of audit often realizes more objectivity than with an employed auditor - ANSWER External audit- the advantage is the independence allows for a more objective review than the one who is employed by the practice. When performing a government audit, the NCCI edits manual can serve what purpose? - ANSWER Support the use of modifiers and can point out bundling errors when performing the audit. An audit performed prior to claims submission is referred to as what type of audit? - ANSWER Prospective audit