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CPMA Chapter 6 Review, Questions and answers, 100% Accurate, graded A+ What is the reason audit findings should be discussed with the provider audited? - -To provide a risk analysis, identify problem areas, and recommend corrective action with supporting documentation What type of information can be found In The providers contract with the insurance carrier? - -The providers obligation to follow the insurance company's medical policies What type of insurance plans may require an audi...

CPMA - LAWS & Abbreviations, Exam Quiz Sections, Full Coverage, rated A+ OIG - -Office of Inspector General HHS - -Health & Human Services PPACA - -Patient Protection and Affordable Care Act Federal Anti-Kickback Law - -prohibits the knowing and willful solicitation, offer, payment, or receipt of any remuneration (broadly interpreted to encompass anything of value), whether direct or indirect, in cash or in like kind, to induce or in return for referring an individual, or pur...

CPMA chapter 1 Top Exam Questions and answers, 100% Accurate, rated A+ Which is considered Medicare abuse? - -Misusing codes on a claim What is the most significant difference between 1996 and 1997 documentation guidelines? - -Examination The goal of the Recovery Audit Contractor (RAC) program is to - -Identify improper payments made on claims of healthcare services provided to Medicare beneficiaries Submitting claims for expired drugs falls under which of the following - -Fals...

CPMA terms, Exam sections Coverage, rated A+ Certificate of compliance agreement - -Require the provider to certify that it will continue to operate its existing compliance programs and to report to OIG for a lesser period of time (usually 3 years) Corporate integrity agreements - -A condition of not seeking exclusion from participation when an entity seeks to settle CIVIL health care fraud cases. Typically last 5 years. Circumstances that the OIG would consider relative to CIA: 1...

CPMA chapter 4, Exam Questions and answers, 100% Accurate, rated A+ An auditor is asked to perform a baseline audit of a multi-provider practice. How many records should be selected for the baseline audit? - -10-15 records per provider An external auditor has been asked to review the E/M visits for a practice. For this focused audit, how should the auditor determine which E/m levels to audit? - -Run a utilization report comparing the providers E/M levels to other providers of the same sp...

CPMA chapter 1, Questions and answers, 100% Accurate. Rated A+ Which is considered Medicare abuse? - -Misusing codes on a claim What is the most significant difference between 1996 and 1997 documentation guidelines? - -Examination The goal of the Recovery Audit Contractor (RAC) program is to - -Identify improper payments made on claims of healthcare services provided to Medicare beneficiaries Submitting claims for expired drugs falls under which of the following - -False Claim Act ...

CPMA Chapter 2.3 & 2.4 - Medical Record Documentation, Questions and answers, rated A+ Commonly found forms in medical records - -1. patient registration form 2. assignment of benefits 3. confirmation of receipt of privacy notice 4. release of information 5. informed consent Patient Registration Form - -Gathers information needed to identify the patient and process claims and typically includes the date, patient demographic information (age, DOB, address, SSN), insurance and financia...

CPMA Certification Study Guide 2018 Chapter 1. Questions and answers, rated A+ How does CMS define fraud? - -Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program. How does CMS define abuse? - -An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly CMS Example of Fraud - -Billing for services and/or supplies that you know were not furnished or provided Altering ...

CPMA Exam Prep 2018 Chapter 1 Part 2, Questions and answers, 100% Accurate, rated A+ OIG - -Office of Inspector General CIA - -Corporate Integrity Agreement CMS - -Centers for Medicare and Medicaid Services FCA - -False Claims Act CMPL - -Civil Monetary Penalties Law Billing for services and /or supplies that you know were not furnished or provided - -CMS example of fraud Altering claim forms and/or receipts to receive a higher payment amount - -CMS example of fraud Bil...

CPMA Top exam questions and answers, 100% Accurate, rated A+ Fraud or Abuse: Billing for a service at a higher level than provided - -Fraud What is a Qua Tam relator? - -A person who brings a civil action for a violation for him/herself & for US Govt What is the difference between Stark Law & Antikickback law? - -No INTENT must be provien for Stark, Antikickpack requires proof of intent When banned for Fed/State healthcare program, what is the term of exclusion (in Years)? - -5 yea...