CPMA EXAM chapter 5
What guidelines should be followed when performing an audit on charts for Medicare beneficiaries?
A) Only CMS policies should be utilized
B) Only local MAC policies should be utilized
C) National CMS policies and local MAC policies should be utilized
D) Neither CMS nor...
What guidelines should be followed when performing an audit on charts for Medicare beneficiaries?
A) Only CMS policies should be utilized
B) Only local MAC policies should be utilized
C) National CMS policies and local MAC policies should be utilized
D) Neither CMS nor local MAC policies should be utilized
Correct answer: C) National CMS policies and local MAC policies should be utilized when performing
Medicare audits. Additionally, it is necessary to know the Medicare Administrative Contractor that
supports the location where services are rendered (e.g., 4x4 rule).
How often should an internal audit be conducted, minimally?
A) Every 2 years
B) Every 3 years
C) Annually (more often if problem is seen)
D) Every 5 years
Correct answer: C) Annually (more often if problem is seen)
What is utilization review?
A) A technique that provides data about how frequently certain services are denied
B) A technique that provides data about how frequently certain services are billed
C) A technique that provides data about how frequently certain services are provided
D) A technique that provides data about how frequently certain services are rejected
, Correct answer: B) A technique that provides data about how frequently certain services are billed. A
utilization pattern can be found by evaluating patterns (data mining).
What is numerical sampling?
A) Sampling based on a random selection of services within a chosen time frame
B) Sampling based on all possible services within a chosen time frame
C) Sampling based on high-frequency items or proportionally significant items
D) Sampling based on low-frequency items or non-significant items
Correct answer: B) Sampling based on all possible services within a chosen time frame. In this
methodology, the sample size is based on all possible services within a certain timeframe. This type of
sample lends itself well to a random final selection.
What are good parameters for a baseline audit?
A) Random audit of 1-5 records per practitioner along with office and surgical procedures selected
randomly
B) Random audit of 10-15 records per practitioner along with office and surgical procedures selected
randomly
C) Random audit of 20-25 records per practitioner along with office and surgical procedures selected
randomly
D) Random audit of 30-35 records per practitioner along with office and surgical procedures selected
randomly
Correct answer: B) Random audit of 10-15 records per practitioner along with office and surgical
procedures selected randomly.
Which resource is valuable when performing a surgical audit?
A) NCCI Manual assists in determining surgical complications
B) NCCI Manual assists in determining bundling issues with CPT code services provided
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