CPMA Chapter 6 Review Questions And Answers Latest Updates
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Course
CPMA
Institution
CPMA
Which option represents information that may be found In A contract between a provider
and a commercial insurance plan that is pertinent to an auditor? - ️️Whether the
provider is obligated to conform to the insurance company's published medical policies
What is the reason audit findings sho...
CPMA Chapter 6 Review
Which option represents information that may be found In A contract between a provider
and a commercial insurance plan that is pertinent to an auditor? - ✔️✔️Whether the
provider is obligated to conform to the insurance company's published medical policies
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
Which section of an audit report would you report consistent findings that attribute to a
specific procedure code or particular provider? - ✔️✔️Issue oriented findings
What type of information can be found In The providers contract with the insurance
carrier? - ✔️✔️The providers obligation to follow the insurance company's medical
policies
What type of insurance plans may require an auditor to identify non-standard coding
and reimbursement rules? - ✔️✔️Auto and workers compensation
When there is a conflict between CMS Internet Only Manuel's and federal regulations,
which provisions take precedence? - ✔️✔️Regulatory provisions
Under the reverse false claims provisions of the False Claims Act, what must be
understood by an auditor? - ✔️✔️Declaring an audit error without binding standards
inappropriately exposes the audited provider to FCA liability
In an audit report, what should be included in the background component? -
✔️✔️Identify of the entity, provider being audited, audit objectives, type of audit, scope
of audit, and identity and qualifications of the auditor should be detailed
Which audit example below represents a prospective audit? - ✔️✔️An audit to evaluate
if a provider's documentation supports ICD 10 CM coding
What is a rebuttal audit? - ✔️✔️An audit in response to a payer audit , and the auditor
is tasked with validating or refuting the conclusion of the payer
In an audit report, which section would identify the specific binding standards or criteria
that were applied during the course of the audit? - ✔️✔️Standard of review
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