100% satisfaction guarantee Immediately available after payment Both online and in PDF No strings attached
logo-home
CPMA Questions and Answers (100% Pass) $13.49   Add to cart

Exam (elaborations)

CPMA Questions and Answers (100% Pass)

 7 views  0 purchase
  • Course
  • CPMA
  • Institution
  • CPMA

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 330...

[Show more]

Preview 4 out of 161  pages

  • October 18, 2024
  • 161
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • CPMA
  • CPMA
avatar-seller
ExamArsenal
1 | P a g e | © copyright 2024/2025 | Grade A+




CPMA Questions and Answers
(100% Pass)
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.




Master01 | September, 2024/2025 | Latest update

, 1 | P a g e | © copyright 2024/2025 | Grade A+

✓ 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.




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.




Master01 | September, 2024/2025 | Latest update

, 1 | P a g e | © copyright 2024/2025 | Grade A+

✓ 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.




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.


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.




Master01 | September, 2024/2025 | Latest update

, 1 | P a g e | © copyright 2024/2025 | Grade A+

✓ 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.




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.




Master01 | September, 2024/2025 | Latest update

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 ExamArsenal. Stuvia facilitates payment to the seller.

Will I be stuck with a subscription?

No, you only buy these notes for $13.49. You're not tied to anything after your purchase.

Can Stuvia be trusted?

4.6 stars on Google & Trustpilot (+1000 reviews)

67096 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
$13.49
  • (0)
  Add to cart