CPMA Study Guide/CPMA prac ce exam A| with
complete solu on | new
The Joint Commission requires that Factors that Affect Learning must be ascertained for a
hospital or hospital owned physician prac ce when assessing this element what does this
include?
*The pa ents ability to read, method learning, & understanding.
*Any language or physical disabili es
*Cultural beliefs.
According to Federal regula ons 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 essen al elements to allow for proper coding of an opera ve report?
*the approach
*type of anesthesia
*loca on & severity of the wounds repaired.
Who is NOT considered a covered en ty under HIPAA?
Health care consultant
What entails the proper authen ca on of an entry in a medical record?
Legible signature of the author and the date the entry is signed.
What is the me limit mandated by CMS for adding a late entry into a medical record?
There is not a me 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 repor ng claim review findings under a Corporate Integre ty Agreement, and
Independent Review organiza on must provide?
A detailed report with an analysis & a narra ve explana on with findings & suppor ng ra onale
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 contrac ng with XYZ all E/M codes filed with EKG interpreta on 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 inten onal fraudulent coding scenario?
Repor ng 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 Prac ces the essen al
elements of a compliance package include?
Conduc ng appropriate training & educa on.
If a pa ent is in the office having an yearly physicial and reports intermiFent abdominal issues
with increasing severity for more than 2 weeks especially aGer ea ng & the physician orders an
abdominal ultrasound, prescribes medica on, and advises followup in 2 weeks. What modifier
would be used to code this encounter?
Modifier 25.
complete solu on | new
The Joint Commission requires that Factors that Affect Learning must be ascertained for a
hospital or hospital owned physician prac ce when assessing this element what does this
include?
*The pa ents ability to read, method learning, & understanding.
*Any language or physical disabili es
*Cultural beliefs.
According to Federal regula ons 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 essen al elements to allow for proper coding of an opera ve report?
*the approach
*type of anesthesia
*loca on & severity of the wounds repaired.
Who is NOT considered a covered en ty under HIPAA?
Health care consultant
What entails the proper authen ca on of an entry in a medical record?
Legible signature of the author and the date the entry is signed.
What is the me limit mandated by CMS for adding a late entry into a medical record?
There is not a me 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 repor ng claim review findings under a Corporate Integre ty Agreement, and
Independent Review organiza on must provide?
A detailed report with an analysis & a narra ve explana on with findings & suppor ng ra onale
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 contrac ng with XYZ all E/M codes filed with EKG interpreta on 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 inten onal fraudulent coding scenario?
Repor ng 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 Prac ces the essen al
elements of a compliance package include?
Conduc ng appropriate training & educa on.
If a pa ent is in the office having an yearly physicial and reports intermiFent abdominal issues
with increasing severity for more than 2 weeks especially aGer ea ng & the physician orders an
abdominal ultrasound, prescribes medica on, and advises followup in 2 weeks. What modifier
would be used to code this encounter?
Modifier 25.
