100% satisfaction guarantee Immediately available after payment Both online and in PDF No strings attached
logo-home
CPMA Exam Questions and Answers $12.49   Add to cart

Exam (elaborations)

CPMA Exam Questions and Answers

 4 views  0 purchase
  • Course
  • CPMA
  • Institution
  • CPMA

EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024. Page 2/136 a. Review based solely on the submitted claims and regulatory guidelines. No medical records are needed. For an automated review, no medical records are needed. Improper payments are de...

[Show more]

Preview 4 out of 136  pages

  • October 15, 2024
  • 136
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • CPMA
  • CPMA
avatar-seller
Emillect
EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024.




CPMA Exam Questions and Answers

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.




Page 1/136

,EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024.



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

are needed.


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?




Page 2/136

,EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024.



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.


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.


Page 3/136

, EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024.



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.


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?


Page 4/136

The benefits of buying summaries with Stuvia:

Guaranteed quality through customer reviews

Guaranteed quality through customer reviews

Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.

Quick and easy check-out

Quick and easy check-out

You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.

Focus on what matters

Focus on what matters

Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!

Frequently asked questions

What do I get when I buy this document?

You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.

Satisfaction guarantee: how does it work?

Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.

Who am I buying these notes from?

Stuvia is a marketplace, so you are not buying this document from us, but from seller Emillect. Stuvia facilitates payment to the seller.

Will I be stuck with a subscription?

No, you only buy these notes for $12.49. You're not tied to anything after your purchase.

Can Stuvia be trusted?

4.6 stars on Google & Trustpilot (+1000 reviews)

75323 documents were sold in the last 30 days

Founded in 2010, the go-to place to buy study notes for 14 years now

Start selling
$12.49
  • (0)
  Add to cart