Cpma exam stuvia - Study guides, Class notes & Summaries

CMS Fraud Definition - answer=Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program CMS Abuse Definition - answer=An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly CMS Examples of Fraud - answer=Billing for services and/or supplies that you know were not furnished or provided, altering claim forms and/or receipts to receive a higher payment amount, billing a Medi...

CMS Fraud Definition - ANSWER Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program CMS Fraud Definition - ANSWER Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program CMS Abuse Definition - ANSWER An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly CMS Abuse Definition - ANSWER An action th...

12.1% - ANSWER # of improper Medicare Fee-For-Service claim payments, according to Federal Government. FFS - ANSWER Fee-For-Service Prepayment Review - ANSWER Review of claims prior to payment. Prepayment reviews result in an initial determination. Postpayment Review - ANSWER Review of claims after payment. May result in either no change to the initial determination or a revised determination, indicating an underpayment or overpayment. Underpayment - ANSWER A payment a provider recei...

What elements must be in a medical record - ANSWER Patient ID, Assignment of Benefits, medical history, immunizations, physical exam, lab report, clinical impression, physician orders What is the minimum signature assignment of the author of entry in the medical record? - ANSWER First initial, Last Name and credentials Based on the JC accreditation guidelines for personal data, what 2 elements must be evident in the medical record? - ANSWER There must be a patient information sheet that co...

Which below is NOT one of the CAT I subsections: a. Anatomic b. Procedural c. Condition d. Service Type - ANSWER d. Service Type Code for influenza immunization status assessed (CAP) a. 1030F b. 1031F c. 1026F d. 1040F - ANSWER a. 1030F. Influenza immunization status assessed (CAP) What are Category II HCPCS codes? a. These are also known as CPT codes b. E & M Codes c. Category I codes are supplemental tracking codes that can be used for performance measurement. d. CMS Trackin...

SOAP - ANSWER Subjective, Objective, Assessment, Plan CHEDDAR - ANSWER Chief complaint, Hx, Exam, Details of problem/complaint, Drugs & dosages, Assessment, Return visit Subjective - ANSWER Pt complaint Objective - ANSWER Provider observation Assessment - ANSWER Medical Dx Plan - ANSWER Treatment You are performing an audit of e/m services for a FP office. In the encounter you read the physician ordered and reviewed a differential WBC. What elements would you expect to see in t...

You are performing an audit of evaluation and management services for a family practice office. In the encounter, you read the physician order and reviewed a differential WBC. Which of the following best describes what you would expect to see in the medical record? - ANSWER Patient identification, assignment of benefits, patient's medical history, immunizations, physical examination, lab report, clinical impression, and physician orders. What is the minimum signature assignment(s) of the aut...

Which statement is true regarding an audit performed on charts for Medicare beneficiaries? - ANSWER National CMS policies and local MAC policies should be utilized when performing Medicare audits. In addition to CMS it is necessary to know your Medicare Administrative Contractor that supports the location where services are rendered for example 4x4 rule. How often should an internal audit be conducted minimally? - ANSWER Annually (more often if problem is seen) What is a utilization review...