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CPMA Top Exam Questions and answers, 100% Accurate, rated A+

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cpma top exam questions and answers
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rated a b if documentation supports the service
have the staff contact the carrier to reprocess the claims code 33010 was valid for the date o

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CPMA Top Exam Questions and
answers, 100% Accurate, rated 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. - ✔✔-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.

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. - ✔✔-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. - ✔✔-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.

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. -
✔✔-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.

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). - ✔✔-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. - ✔✔-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.

d. The 1997 E/M Documentation Guidelines are more detailed using bullets and shading to determine
levels of exams.

b. Hire an OIG employee to oversee the compliance efforts

A comprehensive CIA typically lasts 5 years and includes requirements to:

· hire a compliance officer/appoint a compliance committee;

· develop written standards and policies;

· implement a comprehensive employee training program;

· retain an independent review organization to conduct annual reviews;

· establish a confidential disclosure program;

· restrict employment of ineligible persons;

· report overpayments, reportable events, and ongoing investigations/legal proceedings; and

· provide an implementation report and annual reports to OIG on the status of the entity's compliance
activities. - ✔✔-A Corporate Integrity Agreement (CIA) has core requirements. Which option is NOT one
of the core requirements?

a. Provide an implementation report and annual reports to OIG on the status of the entity's compliance
activities.

, b. Hire an OIG employee to oversee the compliance efforts.

c. Develop written standards and policies.

d. Restrict employment of ineligible persons.

a. OIG Work Plan

Rationale: The HHS OIG publishes its Work Plan on its website that lists the various projects, which are
or will be addressed by the Office of Audit Services, Office of Evaluation and Inspections, Office of
Investigations, and Office of Counsel to the Inspector General. - ✔✔-Which OIG publication identifies
various projects that are and will be addressed by the Office of Audit Services, Office of Evaluation and
Inspections, Office of Investigations, and Office of Counsel to the Inspector General?

a. OIG Work Plan

b. Semiannual Report to Congress

c. Compendium of Unimplemented Recommendations

d. OIG Compliance Plan Guidance

b. The provider must apply for reinstatement.

When the exclusionary period has ended, the individual or entity must apply for reinstatement and
receive authorized notice from OIG that reinstatement has been granted. - ✔✔-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.

a. CPT codebook and MUE (Medical Unlikely Edits) table. - ✔✔-You audit a provider who is consistently
reporting multiple units of CPT code 11042. What references can you use to show the provider multiple
units of CPT code 11042 are not allowed and explain how it should be reported?

a. CPT codebook and MUE (Medical Unlikely Edits) table.

b. CPT codebook and NCCI procedure-to-procedure (PTP) edits.

c. MUE table only.

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