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CPMA Compliance and Regulatory Guidelines (Ch 1) Questions and Answers (100% Pass) $13.49   Add to cart

Exam (elaborations)

CPMA Compliance and Regulatory Guidelines (Ch 1) Questions and Answers (100% Pass)

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CPMA Compliance and Regulatory Guidelines (Ch 1) Questions and Answers (100% Pass)

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  • October 29, 2024
  • 26
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • CPMA
  • CPMA
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ExamArsenal
1|Page | © copyright 2024/2025 | Grade A+




CPMA Compliance and Regulatory
Guidelines (Ch 1) Questions and
Answers (100% Pass)
Operation Restore Trust (ORT)


✓ * Two year partnership of federal and state agencies working together

to protect the healthcare trust fund through shared intelligence and

coordinated enforcement

✓ * Three agencies involved: The Office of the Inspector General (OIG),

the Health Care Financing Administration (now CMS), and the

Administration on Aging (AoA).

✓ * Program is now called Senior Medicare Patrol (CMP) with the HHS,

CMS, and OIG working together to combat fraud and abuse.




Fraud




Master01 | October, 2024/2025 | Latest update

, 1|Page | © copyright 2024/2025 | Grade A+

✓ * CMS defines as knowingly making false statements or misrepresenting

facts to obtain an undeserved benefit or payment from a federal

health care plan.

✓ * Intentional

✓ * Examples include:

✓ 1) Billing for services and/or supplies that you know were not furnished

or provided.

✓ 2) Altering claim forms and/or receipts to receive a higher payment

amount.

✓ 3) Billing for services at a higher level than provided or necessary.

✓ 4) Misrepresenting the diagnosis to justify payment.

✓ 5) Making referrals for certain designated services that are prohibited.




Abuse




Master01 | October, 2024/2025 | Latest update

, 1|Page | © copyright 2024/2025 | Grade A+

✓ * CMS defines as an action resulting in unnecessary costs to a federal

healthcare program, either directly or indirectly.

✓ * Unnecessary costs

✓ * Examples include:

✓ 1) Misusing codes on a claim.

✓ 2) Charging excessively for services or supplies.

✓ 3) Billing for services that were not medically necessary.

✓ 4) Failure to maintain adequate medical or financial records.

✓ 5) Improper billing practices.

✓ 6) Billing Medicare patients a higher fee schedule than non-Medicare

patients.




Federal False Claims Act (FCA) Part 1




Master01 | October, 2024/2025 | Latest update

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