Page | 1
CPMA 2026 QUESTIONS AND
ANSWERS | A+ GRADED | WITH
EXPERT SOLUTIONS
Under CIA, 50 sampling units are reviewed. What is the sample
referred as?
A. Discovery Sample
B. Initial Sample
C. Complete Sample
D. Selective Sample - correct answer -A. Discovery Sample
(used to determine the net financial error rate)
Which may result in false claims act violation?
A. A provider routinely waives the copay for MCR beneficiaries
B. A provider accepts insurance only payments from MCR
beneficiaries
C. A provider submits claims to MCR for DME supplies not
provided to MCR beneficiaries
D. A provider knowingly submits claims to MCR for DME supplies
not provided MCR beneficiaries - correct answer -D. A provider
knowingly submits claims to MCR for DME supplies not provided
MCR beneficiaries
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A Qui Tam Relator may receive what type of award for bringing a
case in which the government intervenes?
A. 15-25% of money recovered
B. 10-15% of money recovered
C. 10-15% of total claim amount
D. 15-40% of total claim amount - correct answer -A. 15-25% of
money recovered
What is the look back period for FFS Recovery Auditors reviewing
claims?
A. 60 days
B. 5 years
C. 15 year
D. 3 years - correct answer -D. 3 years
The OIG lists potential risk areas for physician groups in the
compliance plan guidance. Which option is listed as a risk area?
A. Under Coding
B. Unbundling
C. Overuse of E/M Codes
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D. Failure to follow the same-day rule - correct answer -B.
Unbundling
In the NCCI edits, what does modifier indicator zero (0)
represent?
A. Modifiers are not applicable to the edits
B. The NCCI edit is not in effect
C. A modifier may not be used to bypass the edits if the
documentation supports the modifier
D. A modifier is not allowed to bypass the NCCI edits - correct
answer -D. A modifier is not allowed to bypass the NCCI edits
What can a provider do if he or she disagrees with a demand
letter sent as a result of a recovery audit?
A. Submit a request for review to the MAC within 120 days from
the date of the demand letter
B. Submit a request for review to the MAC within 15 days from the
date of the demand letter
C. Submit a discussion period request within 120 days of the date
of the demand letter
D. Submit a discussion period request within 30 days of the date
of the demand letter - correct answer -D. Submit a discussion
period request within 30 days of the date of the demand letter
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Which of the following best represents an example of fraud?
A. Billing for services at a higher level than provided or necessary
B. Waiving cost-shares or deductibles
C. A pattern of claims for services not medically necessary
D. Failure to maintain adequate medical or financial records -
correct answer -A. Billing for services at a higher level than
provided or necessary
When a physician is banned from participating in any Federal or
State health care program by the OIG under the Exclusion Statue,
what is the minimum term of exclusion applies?
A. 10 years
B. 5 Years
C. 60 Days
D. 1 year - correct answer -B. 5 Years
Which of the following actions is an example of fraud or
misconduct subject to the False Claims act?
A. The provider receives a lab result back and documents in the
patient's chart that the lab result indicates a malignant lesion
B. The provider alters all medical records for lesion excisions to
support the level he reported on the claim
CPMA 2026 QUESTIONS AND
ANSWERS | A+ GRADED | WITH
EXPERT SOLUTIONS
Under CIA, 50 sampling units are reviewed. What is the sample
referred as?
A. Discovery Sample
B. Initial Sample
C. Complete Sample
D. Selective Sample - correct answer -A. Discovery Sample
(used to determine the net financial error rate)
Which may result in false claims act violation?
A. A provider routinely waives the copay for MCR beneficiaries
B. A provider accepts insurance only payments from MCR
beneficiaries
C. A provider submits claims to MCR for DME supplies not
provided to MCR beneficiaries
D. A provider knowingly submits claims to MCR for DME supplies
not provided MCR beneficiaries - correct answer -D. A provider
knowingly submits claims to MCR for DME supplies not provided
MCR beneficiaries
, Page | 2
A Qui Tam Relator may receive what type of award for bringing a
case in which the government intervenes?
A. 15-25% of money recovered
B. 10-15% of money recovered
C. 10-15% of total claim amount
D. 15-40% of total claim amount - correct answer -A. 15-25% of
money recovered
What is the look back period for FFS Recovery Auditors reviewing
claims?
A. 60 days
B. 5 years
C. 15 year
D. 3 years - correct answer -D. 3 years
The OIG lists potential risk areas for physician groups in the
compliance plan guidance. Which option is listed as a risk area?
A. Under Coding
B. Unbundling
C. Overuse of E/M Codes
, Page | 3
D. Failure to follow the same-day rule - correct answer -B.
Unbundling
In the NCCI edits, what does modifier indicator zero (0)
represent?
A. Modifiers are not applicable to the edits
B. The NCCI edit is not in effect
C. A modifier may not be used to bypass the edits if the
documentation supports the modifier
D. A modifier is not allowed to bypass the NCCI edits - correct
answer -D. A modifier is not allowed to bypass the NCCI edits
What can a provider do if he or she disagrees with a demand
letter sent as a result of a recovery audit?
A. Submit a request for review to the MAC within 120 days from
the date of the demand letter
B. Submit a request for review to the MAC within 15 days from the
date of the demand letter
C. Submit a discussion period request within 120 days of the date
of the demand letter
D. Submit a discussion period request within 30 days of the date
of the demand letter - correct answer -D. Submit a discussion
period request within 30 days of the date of the demand letter
, Page | 4
Which of the following best represents an example of fraud?
A. Billing for services at a higher level than provided or necessary
B. Waiving cost-shares or deductibles
C. A pattern of claims for services not medically necessary
D. Failure to maintain adequate medical or financial records -
correct answer -A. Billing for services at a higher level than
provided or necessary
When a physician is banned from participating in any Federal or
State health care program by the OIG under the Exclusion Statue,
what is the minimum term of exclusion applies?
A. 10 years
B. 5 Years
C. 60 Days
D. 1 year - correct answer -B. 5 Years
Which of the following actions is an example of fraud or
misconduct subject to the False Claims act?
A. The provider receives a lab result back and documents in the
patient's chart that the lab result indicates a malignant lesion
B. The provider alters all medical records for lesion excisions to
support the level he reported on the claim
