Exam (elaborations)
Chapter 1 CPMA Exam Prep /155 Questions And Answers Updated
- Course
- Institution
Chapter 1 CPMA Exam Prep /155 Questions And Answers Updated
[Show more]
Seller
Follow
HELLENAH
Reviews received
Content preview
Chapter 1 CPMA Exam Prep /155 Questions AndAnswers Updated 2023-2024
Quiz :12.1% - Answer :# of improper Medicare Fee-For-Service claim
payments, according to Federal Government.
Quiz :FFS - Answer :Fee-For-Service
Quiz :Prepayment Review - Answer :Review of claims prior to payment.
Prepayment reviews result in an initial determination.
Quiz :Postpayment Review - Answer :Review of claims after payment. May
result in either no change to the initial determination or a revised
determination, indicating an underpayment or overpayment.
Quiz :Underpayment - Answer :A payment a provider receives under the
amount due for services furnished under the Medicare statute and regulations.
Quiz :Overpayment - Answer :A payment a provider receives over the amount
due for services furnished under Medicare statutes and regulations
Quiz :5 Common reasons for overpayment are: - Answer :*Billing for excessive
and subsequent payment of the same service or claim.
*Duplicate submission and payment for same service or claim
*Payment for excluded or Medically unnecessary services.
*Payment for services in setting not appropriate to pt's needs or condition
*Payment to an incorrect payee.
Quiz :MACs - Answer :Medicare Administrative Contractors
Quiz :MAC Responsibilities - Answer :Process claims from physicians,
hospitals, and other health care professionals, and submit payment to those
providers according to Medicare rules and regulations (including identifying
under- and overpayments).
Quiz :ZPICs - Answer :Zone Program Integrity Contractors
Quiz :PSCs - Answer :Program Safeguard Contractor
, Quiz :ZPICs/PSCs - Answer :Perform investigations that are unique and
tailored to specific circumstances and occur only in situations where there is
potential fraud, and take appropriate corrective actions
Quiz :SMRC - Answer :Supplemental Medical Review Contractor
Quiz :SMRC Responsibilities - Answer :Conduct nationwide medical review as
directed by CMS (includes identifying underpayments and overpayments
Quiz :Medicare FFS Recovery Auditors - Answer :Review claims to identify
potential underpayments and overpayments in Medicare FFS, as part of the
Recovery Audit Program
Quiz :Zone 6 - Answer :All PSCs transitioned to ZPICs with the exception of
Zone 6
Quiz :While all contractors focus on a specific area, - Answer :Each contractor
conducting a claim review must apply all Medicare policies to the claim under
review. Additionally, once a claim is reviewed, a different contractor should
not reopen it. Therefore, it is important when conducting claim reviews,
contractors review each claim in its entirety.
Quiz :Claim Review Programs - Answer :There are 5 claim review programs
Quiz :NCCI Edits - Answer :National Correct Coding Initiative Editor
Quiz :NCCI Edits are performed by - Answer :Macs, ZPICs, CERT, and Medicare
FFS
Complexity: Non-complex
Quiz :CMS developed the NCCI to - Answer :Promote national correct coding
methods and to control improper coding that leads to inappropriate payment
in Medicare Part B claims. NCCI Edits prevent improper payments when
incorrect code combinations are reported. The NCCI Edits are updated
quarterly.
Quiz :The coding policies are based on the following coding conventions... -
Answer :*American Medical Association (AMA) Current Procedure Terminology
(CPT) Manual
, *National and local Medicare policies and edits
*Coding guidelines developed by the National societies, standard medical and
surgical practice, and current coding practice.
Quiz :PTP - Answer :Procedure-to-Procedure edits
Quiz :Column One/Column Two edit pair - Answer :If a claim contains the two
codes of an edit pair, the Column One code is eligible for payment, but CMS
will deny the Column Two code
Quiz :NCCI edit pairs that are both appropriate - Answer :If both codes are
clinically appropriate, you must append with an appropriate NCCI-associated
modifier to be eligible for payment.
Quiz :Medicare beneficiaries and NCCI edits - Answer :You cannot bill
Medicare beneficiaries for services denied based on NCCI Edits.
Quiz :ABN - Answer :Advance Beneficiary Notice of Noncoverage
Quiz :ABNs and NCCI edits - Answer :When the denials are based on incorrect
coding rather than medical necessity, you cannot use an ABNS (Form CMS-R-
131) to seek payment from a Medicare beneficiary.
Quiz :NCCI edits and Notice of Exclusions from Medicare Benefits - Answer :If
denials are based on incorrect coding rather than a legislated Medicare benefit
exclusion, you cannot use a "Notice of Exclusions from Medicare Benefits"
form to seek payment from a Medicare beneficiary.
Quiz :OCE - Answer :Outpatient Code Editor edits
Quiz :Refer to the OCE edits for claims - Answer :For all Outpatient
institutional providers
Quiz :Refer to NCCI Edits for - Answer :Physician services under the Medicare
Physician Fee Schedule (PFS)
Quiz :PFS - Answer :Physician Fee Schedule
Quiz :While a number of the NCCI Edits are included in the OCE edits - Answer
:The OCE edits are not used within the Medicare PFS (Physician Fee Schedule).
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller HELLENAH. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $9.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
63613 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now