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Certified Professional
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Exam Practice Questions and
Answers
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Additional undocumented services may be used during appeals to justify a claim. Explain.
False. Appeals generally rely on documentation existing within the medical record and
permissible supporting evidence.
Add-on codes are identified by the symbol ________.
+
Are external cause codes always required?
No. Requirements depend on payer policies, reporting requirements, and encounter
circumstances.
Audit conclusions should always be supported by sufficient and appropriate ________.
Evidence.
Audit conclusions should rely entirely on auditor intuition. Explain.
False. Professional judgment must be supported by evidence, standards, and documented
reasoning.
Audit findings should be hidden until corrective actions are completed. Explain.
False. Transparent reporting supports accountability, timely remediation, and informed
decision-making.
Audit hypotheses should be accepted without testing. Explain.
False. Hypotheses must be evaluated objectively using evidence.
An auditor may ignore contradictory documentation if most of the note supports the diagnosis.
Explain.
False. Contradictions should be evaluated and may require clarification because they affect
documentation credibility.
Auditor opinions alone constitute sufficient evidence. Explain.
False. Audit findings must be supported by objective documentation and verifiable evidence.
Auditors can assume patient education occurred if medications were prescribed. Explain.
False. Education must be specifically documented if it is to be considered part of the record.
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Auditors may assume missing documentation supports the billed service. Explain.
False. Auditors cannot make assumptions. Documentation must clearly support all billed
services.
Auditors may infer a diagnosis solely from prescribed medications. Explain.
False. Diagnoses must be explicitly documented by the provider.
Auditors must code based on documentation, not clinical ________.
Assumptions.
Auditors seek sufficient evidence, not necessarily ________ evidence.
Unlimited.
Auditors should adjust findings to avoid upsetting providers. Explain.
False. Findings must be based on evidence and standards, regardless of potential discomfort
or disagreement.
Auditors should evaluate coding accuracy, documentation support, and ________ necessity.
Medical.
Auditors should remain objective and avoid personal ________.
Bias.
Audit reports should be objective, evidence-based, and ________.
Clear.
Audit reproducibility enhances credibility of findings. Explain.
True. Consistent results demonstrate sound methodology and objective evaluation.
Audits help identify coding errors, compliance risks, and educational ________.
Opportunities.
Audit workpapers should be understandable only to the original auditor. Explain.
False. Workpapers should be clear enough for another qualified reviewer to understand
procedures and conclusions.
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Automated audit software eliminates the need for auditor expertise. Explain.
False. Technology assists analysis, but professional judgment remains essential for evaluating
findings and making conclusions.
Benchmarking helps identify unusual coding or billing ________.
Patterns.
Calibration is unnecessary if auditors have extensive experience. Explain.
False. Even experienced auditors benefit from calibration to ensure consistent application of
standards.
Chronic conditions may be coded at every encounter regardless of relevance. Explain.
False. Conditions generally should be assessed, monitored, evaluated, treated, or affect care
during the encounter.
Clearly defined audit objectives help prevent scope ________.
Creep.
Clinical documentation should tell the patient's ________.
Story.
Coders may always assume a causal relationship between two documented conditions.
Explain.
False. Only relationships specifically recognized by coding guidelines may be presumed. Other
relationships require provider documentation.
Coders may assign codes based solely on clinical suspicion if documentation is incomplete.
Explain.
False. Code assignment must be based on provider documentation and applicable coding
guidelines, not assumptions or suspicions.
Coding knowledge alone is sufficient for an effective CPMA audit. Explain.
False. Effective auditing also requires understanding compliance, documentation standards,
reimbursement, risk assessment, and audit methodology.
Complaint-driven audits always confirm wrongdoing. Explain.
False. Complaints trigger review but do not prove that violations occurred.
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Certified Professional Medical Auditor (CPMA) Exam Practice Questions and Answershttps://www.stuvia.com/user/edupac
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edupacr/edupac
Certified Professional
Medical Auditor (CPMA)
Exam Practice Questions and
Answers
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Additional undocumented services may be used during appeals to justify a claim. Explain.
False. Appeals generally rely on documentation existing within the medical record and
permissible supporting evidence.
Add-on codes are identified by the symbol ________.
+
Are external cause codes always required?
No. Requirements depend on payer policies, reporting requirements, and encounter
circumstances.
Audit conclusions should always be supported by sufficient and appropriate ________.
Evidence.
Audit conclusions should rely entirely on auditor intuition. Explain.
False. Professional judgment must be supported by evidence, standards, and documented
reasoning.
Audit findings should be hidden until corrective actions are completed. Explain.
False. Transparent reporting supports accountability, timely remediation, and informed
decision-making.
Audit hypotheses should be accepted without testing. Explain.
False. Hypotheses must be evaluated objectively using evidence.
An auditor may ignore contradictory documentation if most of the note supports the diagnosis.
Explain.
False. Contradictions should be evaluated and may require clarification because they affect
documentation credibility.
Auditor opinions alone constitute sufficient evidence. Explain.
False. Audit findings must be supported by objective documentation and verifiable evidence.
Auditors can assume patient education occurred if medications were prescribed. Explain.
False. Education must be specifically documented if it is to be considered part of the record.
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Auditors may assume missing documentation supports the billed service. Explain.
False. Auditors cannot make assumptions. Documentation must clearly support all billed
services.
Auditors may infer a diagnosis solely from prescribed medications. Explain.
False. Diagnoses must be explicitly documented by the provider.
Auditors must code based on documentation, not clinical ________.
Assumptions.
Auditors seek sufficient evidence, not necessarily ________ evidence.
Unlimited.
Auditors should adjust findings to avoid upsetting providers. Explain.
False. Findings must be based on evidence and standards, regardless of potential discomfort
or disagreement.
Auditors should evaluate coding accuracy, documentation support, and ________ necessity.
Medical.
Auditors should remain objective and avoid personal ________.
Bias.
Audit reports should be objective, evidence-based, and ________.
Clear.
Audit reproducibility enhances credibility of findings. Explain.
True. Consistent results demonstrate sound methodology and objective evaluation.
Audits help identify coding errors, compliance risks, and educational ________.
Opportunities.
Audit workpapers should be understandable only to the original auditor. Explain.
False. Workpapers should be clear enough for another qualified reviewer to understand
procedures and conclusions.
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Automated audit software eliminates the need for auditor expertise. Explain.
False. Technology assists analysis, but professional judgment remains essential for evaluating
findings and making conclusions.
Benchmarking helps identify unusual coding or billing ________.
Patterns.
Calibration is unnecessary if auditors have extensive experience. Explain.
False. Even experienced auditors benefit from calibration to ensure consistent application of
standards.
Chronic conditions may be coded at every encounter regardless of relevance. Explain.
False. Conditions generally should be assessed, monitored, evaluated, treated, or affect care
during the encounter.
Clearly defined audit objectives help prevent scope ________.
Creep.
Clinical documentation should tell the patient's ________.
Story.
Coders may always assume a causal relationship between two documented conditions.
Explain.
False. Only relationships specifically recognized by coding guidelines may be presumed. Other
relationships require provider documentation.
Coders may assign codes based solely on clinical suspicion if documentation is incomplete.
Explain.
False. Code assignment must be based on provider documentation and applicable coding
guidelines, not assumptions or suspicions.
Coding knowledge alone is sufficient for an effective CPMA audit. Explain.
False. Effective auditing also requires understanding compliance, documentation standards,
reimbursement, risk assessment, and audit methodology.
Complaint-driven audits always confirm wrongdoing. Explain.
False. Complaints trigger review but do not prove that violations occurred.
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