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AAPC CASES CPMA Review Questions and Answers (100% Pass)

AAPC CPMA Practice Exam Study Questions and Answers (100% Pass)

which medicare part is reimbursed based on the risk adjustment models part c who typically employs risk adjustment coders health plans is a health plan required to follow the minimum necessary rule yes, health plans are covered entities and are therefore required to follow the minimum necessary rule what is an example of fraud reporting a diagnosis or co-morbidity that does not exist to obtain higher reimbursement which part of medicare is also called medicare advantage part c which health ...

Which of the following actions is considered under the False Claim Act? Upcoding or unbundling services A health plan sends a request for medical records in order to adjudicate a claim. Does the office have to notify the patient or have them sign a release to send the information? No, since the information is used for payment activities it is not necessary to notify or obtain authorization from the patient The Federal False Claim Act allows for claims to be reviewed for a standard of how many ...

Joe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary insurance for their children for billing? A. Joe, because he is the male head of the household. B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd. C. Mary, because her birth year is before Joe's birth year. D. Joe, because his birth month and day are before Mar...

The combining form meaning "joint" is: a. aden/o b.-itis c.-algia d. arthr/o d. arthr/o A suffix meaning "inflammation" is a. -itis b. -osis c. -ac d.-al a. -itis Tumor of a gland a. arthrosis b. arthroscope c. adenoma d. sarcoma c. adenoma Ren/o and nephr/o both mean a. heart b. liver c. gland d. kidney d kidney Which term relates to the brain a. anemia b. cerebral c. rhinitis d. thrombosis b. cerebral A doctor who perform autopsies and examines biopsy samples is a a. oncologis...

When coding in operative report what action would NOT be recommended? Coding from the header with out reading the body of the report If an NCD doesn't exist for a particular service/procedure performed on a Medicare patient who determines coverage? Medicare administrative contractor (MAC) MAC stands for what!? Medicare administrative contractor What is the definition of coding? Translating documentation into numerical/alphabetical codes used to obtain reimbursement. How many components sh...

C (Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for the fiscal year ahead. Within the Work Plan, potential problem areas with claims submissions are listed and will be targeted with special scrutiny.) What document is referenced to when looking for potential problem areas identified by the government indicating scrutiny of the services within the coming year?: A) OIG Compliance Plan Guidance B) OIG Security Summary C) OIG Work Plan D) OIG Investigation Plan D (...

What type of provider goes through approximately 26 1/2 months of education and is licensed to practice medicine with the oversight of a physician? Physician Assistant (PA) The ____ describes whether specific medical items, services, treatment procedures, or technologies are considered medically necessary under Medicare National Coverage Determinations LCD's only have jurisdiction in their ____ area. Regional ABN stands for Advance Beneficiary Notice HIPPA was made into law in what year? ...

"hold harmless clause" * found in some non-Medicare health plan contracts * prohibits billing to patient for anything beyond deductibles and co-pays. A compliance plan may offer several benefits, including: * more accurate payment of claims * fewer billing mistakes * improved documentation and more accurate coding * less chance of violating self-referral and anti-kickback status A healthcare clearing house is a entity that processes nonstandard health information they receive from anothe...