Cpma Study Questions With Complete Solutions

CPMA STUDY QUESTIONS WITH COMPLETE SOLUTIONS WHAT IS THE IMPORTANCE OF AUDIT IN A PRACTICE? - Answer-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 - Answer-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 - Answer-In action resulting in unnecessary cost to a federal healthcare program either directly or indirectly What is the civil penalty - Answer-Not less than 5000 and not more than 10,000 per claim x3 times the amount of government damages Federal False Claims Act - Answer-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 EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024. Page 2/9 Qui Tam - Answer-whistleblower what percentage is offered for a whistleblower/qui tam as an award from what is recovered by the government? - Answer-between 15% and 25% fraud - Answer-Knowingly making false statements or misrepresenting facts to obtain an undeserved benefit or payment from federal healthcare program Discovery sample - Answer-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 - Answer- plan nnual report to congress 3. compendium unimplemented recommendation non-compliant conduct must be documented in compliance files & should include - Answer- 1. date of incident of the reporting party of the person responsible for taking action follow up the action taken What is an auditor - Answer-Reviews healthcare providers policies add procedures to ensure compliance with applicable requirements cms uses what avenues to deliver Information - Answer-sts EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024. Page 3/9 2. transmitting ls medicare learning network CIA Corporate Integrity Agreement - Answer-Last five years can be longer if OIG likes OIG will require CIA as a condition for not seeking exclusion from participation when they seek to settle civil fraud cases requirements hearing compliance officer/ appointments compliance committee , employee training program,IRO (IRO) independent review organization - Answer-(Third-party medical review resource) 1. Provides objective unbiased audits and reports. 2. OIG can notify provider within 30 days if IRO is unacceptable and may request IRO be terminated and another IRO be retained. Civil Monetary Penalties Law (CMP) - Answer-(Improper filing of claims- Upcoding, miscoding) 1. Knowing it's a false claim. 2. Knowing Dr. is not licensed. 3. Changing DOS to when PT was effective with a government plan. 4. Knowing it's not medically necessary. *Penalties 10,000 to 50,000 per violation up to $22,363 for each item/service and 3X the amount improperly claimed. If disagree* can request hearing before an HHS administrative law judge. Anti-Kickback Law - Answer-(Applies to anyone not just