Chapter 1 CPMA Exam Prep Questions and Answers (100% Pass)
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Course
CPMA
Institution
CPMA
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 ...
✓ Conduct nationwide medical review as directed by CMS (includes
identifying underpayments and overpayments
Medicare FFS Recovery Auditors
✓ Review claims to identify potential underpayments and overpayments
in Medicare FFS, as part of the Recovery Audit Program
Zone 6
✓ All PSCs transitioned to ZPICs with the exception of Zone 6
While all contractors focus on a specific area,
✓ Each contractor conducting a claim review must apply all Medicare
policies to the claim under review. Additionally, once a claim is
reviewed, a different contractor should not reopen it. Therefore, it is
important when conducting claim reviews, contractors review each
claim in its entirety.
Claim Review Programs
✓ There are 5 claim review programs
NCCI Edits
Master01 | September, 2024/2025 | Latest update
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