CPMA Final Exam Review Questions and Verified Answers| Grade A+ | 100% Correct (2024/ 2025 Update) 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 doe s this include? A. The patient's ability to read, method of learning and understanding. B. Any language or physical disabilities. C. Cultural beliefs. D. All the above ✔✔D. All the above Report copies and printouts, films, scans, and other radio logic service image records must be retained for how long according to Federal Regulations? A. 10 years B. 7 years C. 5 years D. 3 years ✔✔C. 5 years At which point should a provider repay over payments reported by self -disclosure to the office of Inspector General? A. Make the payment to your carrier immediately. B. Make the payment at the conclusion of the OIG injury. C. Make the payment to the carrier prior to the self disclosure. D. Make the payment to the OIG with a self disclosure rep ort. ✔✔B. Make the payment at the conclusion of the OIG injury Which of the following may be considered essential element (s) of an operative report and will allow for accurate coding? A. The approach B. The type of anesthesia required C. The location and severity of wounds repaired D. All of the above ✔✔D. All of the above Which of the following is NOT a covered entity under HIPPA? A. Physician B. Health Plan C. Health Care Consultant D. Physician Assistant ✔✔C. Health Care Consultant When referring to the authentication of a medical record entry, what does this entail? A. Legible signature of author and date signed B. A physician's order for ancillary services C. An original document filed in the record D. The patient's personal information ✔✔A. Le gible signature of author and date signed What is the time limit mandated by CMS for adding a late entry to the medical record? A. One Week B. One Month C. One Year D. No time limit ✔✔D. No time limit When should a ABN be signed? A. Prior to per forming a statutorily excluded procedure for a Medicare beneficiary. B. Prior to performing a procedure that may be denied due to medical necessity for a Medicare beneficiary. C. Prior to submitting a claim to Medicaid for a non - service. D. After pe rforming a procedure and finding it is denied. ✔✔B. Prior to performing a procedure that may be denied due to medical necessity for a Medicare beneficiary. Under a Corporate Integrity Agreement (CIA), how many claims must be randomly selected to review to determine the financial error rate? A. 15 B. 50 C. 75 D. 100 ✔✔B. 50 When using LCDs and CMS program Guidance as a resource for an audit, what should the auditor keep in mind? A. QICs are bound by NCDs, LMRPs, and CMS Program guidance, but ALJs and MACs are not. B. Local carriers and QICs are bound by LCDs and LMRPs C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs, ALJs, and MACs are not bound by them. D. Local Carriers, QICs, ALJs, and MACs are all bound by NCDs and CMS program g uidance. ✔✔C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs, ALJs, and MACs are not bound by them. When reporting the claims review findings under a CIA audit, the Independent Review Organization (IRO) must provide: A. A detailed analysis listing the patient files reviewed and findings and previous audit disclosures for all services B. A detailed report with a narrative explanation of finding and supporting rationale approved by the providers attorney. C. A detailed report wit h an analysis and narrative explanation with findings and supporting rationale regarding the claim review, including the results of the discovery or full sample. D. A list of data reviewed and findings in a narrative form ✔✔C. A detailed report with an analysis and narrative explanation with findings and supporting rationale regarding the claim review, including the results of the discovery or full sample. Which statement is most accurate regarding NCCI? A. NCCI are national coding guidelines and must be followed regardless of the insurance carrier. B. You need to check individual carriers to see if they follow NCCI or if they have their own set of bundling edits. C. Each individual carrier will have its own bundling edits and will not use NCCI.
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