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 informati...
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 auditor to identify non-standard coding and
reimbursement rules? - ✔✔-Auto and workers compensation
When there is a conflict between CMS Internet Only Manuel's and federal regulations, which provisions
take precedence? - ✔✔-Regulatory provisions
Under the reverse false claims provisions of the False Claims Act, what must be understood by an
auditor? - ✔✔-Declaring an audit error without binding standards inappropriately exposes the audited
provider to FCA liability
In an audit report, what should be included in the background component? - ✔✔-Identify of the entity,
provider being audited, audit objectives, type of audit, scope of audit, and identity and qualifications of
the auditor should be detailed
Which audit example below represents a prospective audit? - ✔✔-An audit to evaluate if a provider's
documentation supports ICD 10 CM coding
What is a rebuttal audit? - ✔✔-An audit in response to a payer audit , and the auditor is tasked with
validating or refuting the conclusion of the payer
In an audit report, which section would identify the specific binding standards or criteria that were
applied during the course of the audit? - ✔✔-Standard of review
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