CPMA Exam Questions And Answers
Fraud or Abuse? Misrepresenting a DX to justify payment? Fraud
Fraud or Abus? Improper billing practices Abuse
Fraud or Abuse? Altering claim forms and/or receipts to receive a higher payment amount.
Fraud
Fraud or Abuse? Billing Medicare patients a higher fee schedule compared to non-Medicare
patients. Abuse
What does FCA stand for? Federal False Claims Act
How else is the Start Law referred? Physician self-referral law
How many federal OIGs are there? 73
, CPMA Exam Questions And Answers
What is the CIA? Corporate Integrity Agreements lasting typically 5 years as a guideline
to help providers that have been excluded.
When CIAs require claim reviews what is considered the DISCOVERY sample? 50
claims randomly selected (95% accuracy required)
What are the fundamental elements for an effective compliance program? 1. Written
policies 2. Compliance officer/committee 3. Training/education 4. Communication
5.Enforcement of standars & disciplinary actions 6. Internal audtis 7. respond & develope
corrective action plan
In a Corporate Integrity Agreement (CIA) does the OIG specify the IRO to be used? NO,
but the OIG does retain the right to notify the provider if they must select a new IRO
When non-compliance is identified, what does the OIG suggest? Take disciplinary action
& document the date of the incident, the name of the reporting party, name of the person
responsible for taking action and the f/u action taken.
The OIG lists potential risks for individual/small group practices compliance plans. Name a
potential risk area UNBUNDLING
Fraud or Abuse? Misrepresenting a DX to justify payment? Fraud
Fraud or Abus? Improper billing practices Abuse
Fraud or Abuse? Altering claim forms and/or receipts to receive a higher payment amount.
Fraud
Fraud or Abuse? Billing Medicare patients a higher fee schedule compared to non-Medicare
patients. Abuse
What does FCA stand for? Federal False Claims Act
How else is the Start Law referred? Physician self-referral law
How many federal OIGs are there? 73
, CPMA Exam Questions And Answers
What is the CIA? Corporate Integrity Agreements lasting typically 5 years as a guideline
to help providers that have been excluded.
When CIAs require claim reviews what is considered the DISCOVERY sample? 50
claims randomly selected (95% accuracy required)
What are the fundamental elements for an effective compliance program? 1. Written
policies 2. Compliance officer/committee 3. Training/education 4. Communication
5.Enforcement of standars & disciplinary actions 6. Internal audtis 7. respond & develope
corrective action plan
In a Corporate Integrity Agreement (CIA) does the OIG specify the IRO to be used? NO,
but the OIG does retain the right to notify the provider if they must select a new IRO
When non-compliance is identified, what does the OIG suggest? Take disciplinary action
& document the date of the incident, the name of the reporting party, name of the person
responsible for taking action and the f/u action taken.
The OIG lists potential risks for individual/small group practices compliance plans. Name a
potential risk area UNBUNDLING
