CPMA EXAM QUESTIONS AND ANSWERS

Which option is NOT part of the seven elements that should be included in a compliance plan based on the OIG's recommendations? a. Responding promptly to detected offenses and developing corrective action. b. Conducting effective training and education. c. Identifying employees on the exclusions list. d. Developing effective lines of communication. - Answer- c. Identifying employees on the exclusions list. The OIG's Compliance Program Guidance for Individual and Small Physician Group Practices identifies four risk areas affecting physician practices. What are the four risk areas? - Answer- Coding and billing; reasonable and necessary services; documentation; and improper inducements, kickbacks, and self-referrals. What does the MUE table tell? - Answer- maximum number of units a procedure can be reported on the same date of service What does MUE stand for? - Answer- Medically Unlikely Edits What does CMS stand for? - Answer- Centers for Medicare and Medicaid What does CIA stand for? - Answer- Corporate Integrity Agreeement What is a corporate integrity agreement? - Answer- Document outlining the obligations that a company involved in health care in the United States makes with a federal government agency or a state government as part of a civil settlement Which is not a core requirement of CIAs? a. Restrict employment of ineligible persons. b. Hire an OIG employee to oversee the compliance efforts. c. Develop written standards and policies. d. Provide an implementation report and annual reports to OIG on the status of the entity's compliance activities. - Answer- b. Hire an OIG employee to oversee the compliance efforts. What is a Complex audit review? - Answer- A complex review is based on data and potential human review of a medical record or other documentation. What is an automated audit review? - Answer- Review based solely on the submitted claims and regulatory guidelines. No medical records are needed. What is Qui Tam Relator? - Answer- A person who brings a civil action for a violation for him/herself and for the US Government