CPMA Already Rated A+
1. What should be assessed when evaluating the Factors that Affect Learning in a hospital or healthcare
facility?
A) The patient's ability to read and understand medical information
B) The patient's cultural background and beliefs
C) Any physical or language disabili...
CPMA Already Rated A+
1. What should be assessed when evaluating the Factors that Affect Learning in a hospital or healthcare
facility?
A) The patient's ability to read and understand medical information
B) The patient's cultural background and beliefs
C) Any physical or language disabilities that may affect learning
D) The patient's socioeconomic status
Correct answer: D) All of the above
2. How long must report copies and printouts, films, scans, and other radiologic service image records
be retained according to Federal Regulations?
A) 3 years
B) 5 years
C) 7 years
D) 10 years
Correct answer: B) 5 years
3. When should a provider repay overpayments reported by self-disclosure to the Office of Inspector
General (OIG)?
A) Immediately upon reporting the overpayment
B) At the conclusion of the OIG investigation
C) Prior to reporting the overpayment
D) After receiving a demand letter from the OIG
,Correct answer: B) At the conclusion of the OIG investigation
4. What elements are considered essential in an operative report to allow for accurate coding?
A) The type of anesthesia used and any complications that occurred
B) The location and severity of wounds repaired, as well as any equipment used during the procedure
C) The surgeon's name and credentials
D) All of the above
Correct answer: D) All of the above
5. Which of the following is NOT a covered entity under HIPAA?
A) Health plan
B) Healthcare provider
C) Healthcare consultant
D) Physician assistant
Correct answer: C) Healthcare consultant
What is the time limit mandated by CMS for adding a late entry to the medical record?
A. One Week
B. One Month
C. One Year
D. No time limit ✔️D. No time limit
When should a ABN be signed?
A. Prior to performing a statutorily excluded procedure for a Medicare beneficiary.
,B. Prior to performing a procedure that may be denied due to medical necessity for a Medicare
beneficiary.
C. Prior to submitting a claim to Medicaid for a non- service.
D. After performing a procedure and finding it is denied. ✔️B. Prior to performing a procedure that may
be denied due to medical necessity for a Medicare beneficiary.
Under a Corporate Integrity Agreement (CIA), how many claims must be randomly selected to review to
determine the financial error rate?
A. 15
B. 50
C. 75
D. 100 ✔️B. 50
When using LCDs and CMS program Guidance as a resource for an audit, what should the auditor keep
in mind?
A. QICs are bound by NCDs, LMRPs, and CMS Program guidance, but ALJs and MACs are not.
B. Local carriers and QICs are bound by LCDs and LMRPs
C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs, ALJs, and MACs are not
bound by them.
D. Local Carriers, QICs, ALJs, and MACs are all bound by NCDs and CMS program guidance. ✔️C. Local
carries follow LCDs, LMRPs, and CMS program guidance, but QICs, ALJs, and MACs are not bound by
them.
, When reporting the claims review findings under a CIA audit, the Independent Review Organization
(IRO) must provide:
A. A detailed analysis listing the patient files reviewed and findings and previous audit disclosures for all
services
B. A detailed report with a narrative explanation of finding and supporting rationale approved by the
providers attorney.
C. A detailed report with an analysis and narrative explanation with findings and supporting rationale
regarding the claim review, including the results of the discovery or full sample.
D. A list of data reviewed and findings in a narrative form ✔️C. A detailed report with an analysis and
narrative explanation with findings and supporting rationale regarding the claim review, including the
results of the discovery or full sample.
Which statement is most accurate regarding NCCI?
A. NCCI are national coding guidelines and must be followed regardless of the insurance carrier.
B. You need to check individual carriers to see if they follow NCCI or if they have their own set of
bundling edits.
C. Each individual carrier will have its own bundling edits and will not use NCCI.
D. NCCI edits are suggested ways to bundle procedure codes, but are not necessary to review during an
audit. ✔️B. You need to check individual carriers to see if they follow NCCI or if they have their own set
of bundling edits.
A provider request you to perform an audit of claims that have been denied payment by XYZ insurance.
Since the physician contracted with XYZ insurance, all claims submitted that include the E/M service and
EKG interpretation on the same day have been denied for the EKG interpretation. You review the
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