CPMA Study Guide CORRECT 100%
The Joint Commission requires that Factors that Affect Learning must be ascertained
for a hospital or hospital owned physician practice when assessing this element what
does this include? - ANSWER*The patients ability to read, method learning, &
understanding.
*Any language or physical disabilities
*Cultural beliefs.
What is the time limit mandated by CMS for adding a late entry into a medical record? -
ANSWERThere is not a time limit.
When should an ABN be signed? - ANSWERPrior 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? - ANSWER50 charts.
When using LCD and CMS Program Guidance for a resource for an audit, what should
the auditor keep in mind? - ANSWERLocal carriers follow LCDs, LMRPs, and CMS
Guidance Programs but QICs, ALJs, and MACs are not bound by them.
When reporting claim review findings under a Corporate Integretity Agreement, and
Independent Review organization must provide? - ANSWERA detailed report with an
analysis & a narrative explanation with findings & supporting rationale regarding the
claim review including the results of the discovery or full sample.
Accurate statement about NCCI? - ANSWERYou 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 contracting with XYZ all E/M codes filed with EKG interpretation
have been denied, but you review & claims are correct. What is next step you would
take? - ANSWERLook at the provider contract with XYZ to see if this is excluded for
payment.
What is an example of intentional fraudulent coding scenario? - ANSWERReporting
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 Practices the
essential elements of a compliance package include? - ANSWERConducting
appropriate training & education.
According to Federal regulations how long must report copies and printouts of films,
scans, & other radiological image services be kept? - ANSWER5 years.
The Joint Commission requires that Factors that Affect Learning must be ascertained
for a hospital or hospital owned physician practice when assessing this element what
does this include? - ANSWER*The patients ability to read, method learning, &
understanding.
*Any language or physical disabilities
*Cultural beliefs.
What is the time limit mandated by CMS for adding a late entry into a medical record? -
ANSWERThere is not a time limit.
When should an ABN be signed? - ANSWERPrior 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? - ANSWER50 charts.
When using LCD and CMS Program Guidance for a resource for an audit, what should
the auditor keep in mind? - ANSWERLocal carriers follow LCDs, LMRPs, and CMS
Guidance Programs but QICs, ALJs, and MACs are not bound by them.
When reporting claim review findings under a Corporate Integretity Agreement, and
Independent Review organization must provide? - ANSWERA detailed report with an
analysis & a narrative explanation with findings & supporting rationale regarding the
claim review including the results of the discovery or full sample.
Accurate statement about NCCI? - ANSWERYou 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 contracting with XYZ all E/M codes filed with EKG interpretation
have been denied, but you review & claims are correct. What is next step you would
take? - ANSWERLook at the provider contract with XYZ to see if this is excluded for
payment.
What is an example of intentional fraudulent coding scenario? - ANSWERReporting
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 Practices the
essential elements of a compliance package include? - ANSWERConducting
appropriate training & education.
According to Federal regulations how long must report copies and printouts of films,
scans, & other radiological image services be kept? - ANSWER5 years.
