CPMA QUESTIONS WITH VERIFIED ANSWERS COMPILED

Medically Unlikely Edits - Define the maximum units of service that a provider would report, under most circumstances, for a single beneficiary, on a single date of service, for a specific HCPCS/CPT code Purpose of the medically unlikely edits - To help reduce the paid claims error rate for Med...

ALJ - Administrative law judge OIG - Office of Inspector General CIA - Corporate Integrity Agreement IRO - Independent Review Organization HHS - Health and Human Services LEIE - List of Excluded Individuals /Entities CMPL - Civil Monetary Penalties Law NIH - National Ins...

In the NCCI edits, what does modifier indicator nine represent? A. A modifier is not allowed to bypass the NCCI edits B. A modifier may be used to bypass the edits if the documentation supports the modifier C. Modifiers are not applicable he edits, the NCCI edit is not in effect D. Only modifie...

Medical Review Program is performed by - Macs, ZPICs/PSCs, and SMRCs Claim Review contractors identify suspected improper billing through - Error rates produced by the CERT Program, vulnerabilities identified through the Recovery Audit Program, claim data analysis, and evaluation of other infor...