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CPMA Exam Questions and Answers | 100% Pass

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CPMA Exam Questions and Answers | 100% Pass B. If documentation supports the service, have the staff contact the carrier to reprocess the claims. Code 33010 was valid for the date of service billed. Rationale: The effective dates of codes are date of service driven. New CPT® codes become effe...

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  • October 3, 2024
  • 123
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • CPMA
  • CPMA
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EmillyCharlotte
EMILLYCHARLOTTE 2024/2025 ACADEMIC YAER
©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED
FIRST PUBLISH SEPTEMBER 2024

CPMA Exam Questions and Answers |
100% Pass

B. If documentation supports the service, have the staff contact the carrier to reprocess

the claims. Code 33010 was valid for the date of service billed.

Rationale: The effective dates of codes are date of service driven. New CPT® codes

become effective January 1st of every year. When auditing, verify codes based on the

codes that were valid during the date of service. - Answer✔✔-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 33010 was deleted efective 1/1/2020. Determine the correct new code and

have staf resubmit claims.

B. If documentation supports the service, have the staf contact the carrier to reprocess

the claims. Code 55450 was valid for the date of service billed.

C. Code 33010 was deleted efective 1/1/2020. Tis is a valid denial. Advise the staf to

write of the balance.

D. Code 33010 was efective for the date of service. Advise the staf to add modifer 59

and resubmit the claim.

a. Review based solely on the submitted claims and regulatory guidelines. No medical

records are needed.



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,EMILLYCHARLOTTE 2024/2025 ACADEMIC YAER
©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED
FIRST PUBLISH SEPTEMBER 2024
For an automated review, no medical records are needed. Improper payments are

determined based solely on the submitted claims and regulatory guidelines such as

National Coverage Determinations, Local Coverage Determinations, and the CMS

Manuals. - Answer✔✔-Recovery auditors may perform two types of reviews. What is

an automated review?

a. Review based solely on the submitted claims and regulatory guidelines. No medical

records are needed.

b. Review based on data and potential human review of a medical record or other

documentation.

c. Medical records are required for the review.

d. Review is based solely on denials received.

b. 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.

According to the OIG, disciplinary action should be taken based on the severity of the

offense. Disciplinary actions could include oral warnings, written reprimands, probation,

demotions, termination, etc. The incident should be documented with the date of the

incident, name of the reporting party, name of the person responsible for taking action,

and the follow-up action taken. - Answer✔✔-When non-compliance is identified, what

does the OIG recommended?

a. Take disciplinary action and document the date of the incident, name of the person

responsible for taking action, the follow-up action taken, and a list of claims that were

affected by the action.


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,EMILLYCHARLOTTE 2024/2025 ACADEMIC YAER
©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED
FIRST PUBLISH SEPTEMBER 2024
b. 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.

c. Immediately terminate employment for the party found in non-compliance, regardless

of the severity of the offense, document the date of the termination, file a corrected

claim on all claims affected.

d. Continue to watch the employee in non-compliance until the incidents meet a federal

level before taking action.

d. No; the OIG does not specify the IRO to be used, but does retain the right to notify

the provider if they must select a new IRO.

The OIG will not endorse any particular IRO, but most CIAs include language that gives

the OIG the opportunity to notify a provider that its choice of IRO is unacceptable within

30 days after the OIG receives written notice of the identity of the IRO. If the OIG has

concerns regarding the quality of the review or qualifications or independence of the

IRO during the term of the CIA, it will make the concerns known and may request that

the agreement with the IRO be terminated and another IRO be retained. -

Answer✔✔-In a Corporate Integrity Agreement (CIA), does the OIG specify the

Independent Review Organization to be used?

a. Yes; the specific IRO will be named in the CIA.

b. Yes; the CIA will identify five IROs that can be used for the CIA Review.

c. No; the OIG does not have any input on the IRO used under any circumstance.

d. No; the OIG does not specify the IRO to be used, but does retain the right to notify

the provider if they must select a new IRO.


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, EMILLYCHARLOTTE 2024/2025 ACADEMIC YAER
©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED
FIRST PUBLISH SEPTEMBER 2024
d. The provider can request a hearing before an ALJ in the HHS.

If the subject receiving a demand letter from the OIG disagrees, he/she can request a

hearing before an administrative law judge (ALJ) in Health and Human Services (HHS).

- Answer✔✔-What rights does a provider have if he/she disagrees with a demand

letter sent by the OIG?

a. The provider can choose to self-disclose once a demand letter has been received.

b. The provider can send in supporting documentation for the claims to the OIG for

review by certified mail.

c. The provider can only respond to the demand letter with payment.

d. The provider can request a hearing before an ALJ in the HHS.

d. The 1997 E/M Documentation Guidelines are more detailed using bullets and

shading to determine levels of exams.

The 1995 E/M Documentation Guidelines are vague in the description of the exam

whereas the 1997 E/M Documentation Guidelines are more detailed using bullets and

shading to determine levels of exams. - Answer✔✔-Which statement is TRUE

regarding 1995 and 1997 E/M Documentation Guidelines?

a. The 1995 E/M Documentation Guidelines are more detailed using bullets and

shading to determine levels of exams.

b. The 1995 E/M Documentation Guidelines are never beneficial for specialists.

c. The 1997 E/M Documentation Guidelines are never beneficial for general

practitioners.




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