CPMA- Chapter one exam Questions and Answers
In the NCCI edits, what does modifier indicator nine (9) represent?
A modifier may be used to bypass the edits if the documentation supports the modifier.
B. A modifier is not allowed to bypass the NCCI edits.
C. Only modifier 59 can be used to bypas...
9 = The use of modifiers is not specified. This indicator is used for all code pairs that have a
deletion date that is the same as the effective date. This indicator was created so that no blank
spaces would be in the indicator field.
A provider consistently charges a higher level of E/M service than is documented to help cover
the cost of his declining practice. Would this be fraud or abuse, and why?
a. Abuse; the provider's practice is common and therefore would not be considered fraudulent.
b. Abuse; charging one level higher on each visit does not show intent.
c. Fraud; the provider intentionally over-coded to gain financially.
d. Fraud; any over-coding of services would be considered fraudulent. - Answer✔✔-C. Fraud;
the provider intentionally over-coded to gain financially.
Response Feedback: Rationale: The difference between fraud and abuse is intent.
Based on the compliance program guidance documents by the OIG, what should be
documented when non-compliant conduct is found?
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