CPMA Questions and Answers (100% Pass)

12.1% # of improper Medicare Fee-For-Service claim payments, according to Federal Government. FFS Fee-For-Service Prepayment Review Review of claims prior to payment. Prepayment reviews result in an initial determination. Postpayment Review Review of claims after payment. May result i...

In February 2020, an auditor is asked to review 10 records for date of service 12/1/2019 to make sure the claims were paid correctly. Te claims included code 33010, which was denied on all the claims. Te denial was for an invalid code. What should the auditor advise the provider? A. Code 3301...

The Joint Commission (JC) requires the Factors that Affect Learning must be assessed for a hospital or hospital owned physician practice as well as other health care facilities. When assessing this element what does this include? A. The patient's ability to read, method of learning and under...

Understanding how to develop and draft a well-structured and detailed audit report is a critical skill for any competent auditor. The audit report should identify the key findings and present the analysis, rationale and recommendations in a format that is easy for the auditee to read, under...

What is the reason audit findings should be discussed with the provider audited? To provide a risk analysis, identify problem areas, and recommend corrective action with supporting documentation What type of information can be found In The providers contract with the insurance carrier? Th...

Accurate reimbursement begins with accurate coding and rules that vary by payer The CPT codebook contains instructions, coding guidelines, parenthetical notes, and symbols to provide guidance for proper coding. Not all payers follow CPT coding guidelines. An auditor must be able to apply p...

CMS Fraud Definition Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program CMS Abuse Definition An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly CMS Examples of...

When non-compliance is identified, what does the OIG recommended? a .Take disciplinary action and document the date of the incident, name of the reporting party, name of the person responsible for taking action, and the follow-up action taken. b. Take disciplinary action and document the date ...