Exam (elaborations)

Cpma Quiz Bank. Top Exam Questions and answers, 100% Accurate, rated A+

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Cpma

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Cpma

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Uploaded on February 13, 2023
Number of pages 61
Written in 2022/2023
Type Exam (elaborations)
Contains Questions & answers

cpma quiz bank top exam questions and answers
100 accurate
rated a when non compliance is identified
what does the oig recommended a take disciplinary action and document the date of the in

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Cpma Quiz Bank. Top Exam Questions
and answers, 100% Accurate, rated A+

When non-compliance is identified, what does the OIG recommended?

a .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.

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. - ✔✔-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

A provider consistently charges a higher level E/M service than is documented to help cover the cost of
his declining practice. Would this be fraud or abuse Why?

a. Abuse,charging one level higher on each visits does not show intent.

b. Abuse; the provider's practice is common and therefore would not be considered fraudulent .

c. Fraud; and over-coding of services would be considered fraudulent.

d. Fraud; the provider intentionally over-coded to gain financially. - ✔✔-d. Fraud; the provider
intentionally over-coded to gain financially.

,The OIG lists potential risk areas for individual and small physician groups in the compliance plan
guidance. Which option below is listed as a risk area?

a. Unbundling

b. Under Coding

c. Overuse of E/M codes

d. Failure to follow the "same day" rule - ✔✔-a. Unbundling

The FCA allows for reduced penalties if the person in violation self-discloses if which conditions exist?

a. The person furnishes all information about the violation with in 30 days after which the defendant
first obtained the information.

b. The person fully cooperates with the investigation.

c. There is no additional criminal prosecution, civil action, or administrated action with the respect to
the violation.

d. All of the above - ✔✔-d. All of the above

What is a Qui Tam Relator?

a. a person who is prosecuted under FCA.

b. The defendant in a Stark Law case.

c. a person listed on the OIG exclusions list.

,d. a person who brings civil action for violation under the FCA for themselves and the government. -
✔✔-d. a person who brings civil action for violation under the FCA for themselves and the government.

What is CoP?

a. Medicare Conditions of Participation.

b. TriCare's Compliance of Physicians Guidance

c. Medicaid's Coordination of Physician Groups

d. Commercial Programs - ✔✔-a. Medicare Conditions of Participation.

When a provider is excluded under the Exclusions statute, What must he or she do at the end of the
exclusionary period?

a. the provider is automatically reinstated

b. The provider must apply for reinstatement.

c. The provider cannot be reinstated once excluded.

d. The provider must apply for a group provider number. - ✔✔-b. The provider must apply for
reinstatement

Which option is considered a material breach of CIA?

a. Failure to engage and use an IRO in accordance with the CIA.

b. Failure to hire an OIG employee to oversee compliance efforts.

c. Failure to hire a full-time internal auditor to review every claim before it is submitted.

, d. Failure to fire auditors who do not agree with the provider's coding - ✔✔-a. Failure to engage and use
an IRO in accordance with the CIA.

CMS has two sets of Evaluation and Management Documentations Guidelines , 1995 and 1997. Which
set is used by physicians for office visits?

a. 1995 E/M Documentation Guidelines

b. 1997 E/M Documentation Guidelines

c. The practice must choose either the 1995 or 1997 E/M Documentation Guidelines for the entire
practice.

d. The practice may use 1995 or 1997 E/M Documentation Guidelines for each visit; whichever is most
advantageous for that visit. - ✔✔-d. The practice may use 1995 or 1997 E/M Documentation Guidelines
for each visit; whichever is most advantageous for that visit.

What is a semi-automated review?

a. a review based on electronic data examined form submitted claims .

b. A review based on electronic data examined from submitted claims but electively supported by
medical records sent by the provider.

c. a review based on complete medical records review due lack of Medical Policy being in a place

d. a review based on tips sent in from internal informants. - ✔✔-b. A review based on electronic data
examined from submitted claims but electively supported by medical records sent by the provider.

Which option is NOT part of the seven elements that should be included in a compliance plan based on
the OIG's recommendations?

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