CPMA EXAM 2026 WITH 100%
ACCURATE QUESTIONS & ANSWERS
The Joint Commission (JC) requires the Factors that Affect Learning must be assessed for a
hospital or hospital owned physician practice as well as other health care facilities. When
assessing this element what does this include?
A. The patient's ability to read, method of learning and understanding.
B. Any language or physical disabilities.
C. Cultural beliefs.
D. All the above - Precise Answer ✔✔D. All the above
Report copies and printouts, films, scans, and other radio logic service image records must be
retained for how long according to Federal Regulations?
A. 10 years
B. 7 years
C. 5 years
D. 3 years - Precise Answer ✔✔C. 5 years
At which point should a provider repay over payments reported by self-disclosure to the office
of Inspector General?
A. Make the payment to your carrier immediately.
B. Make the payment at the conclusion of the OIG injury.
C. Make the payment to the carrier prior to the self disclosure.
D. Make the payment to the OIG with a self disclosure report. - Precise Answer ✔✔B. Make the
payment at the conclusion of the OIG injury
Which of the following may be considered essential element (s) of an operative report and will
allow for accurate coding?
A. The approach
B. The type of anesthesia required
C. The location and severity of wounds repaired
D. All of the above - Precise Answer ✔✔D. All of the above
,Which of the following is NOT a covered entity under HIPPA?
A. Physician
B. Health Plan
C. Health Care Consultant
D. Physician Assistant - Precise Answer ✔✔C. Health Care Consultant
When referring to the authentication of a medical record entry, what does this entail?
A. Legible signature of author and date signed
B. A physician's order for ancillary services
C. An original document filed in the record
D. The patient's personal information - Precise Answer ✔✔A. Legible signature of author and
date signed
What is the time limit mandated by CMS for adding a late entry to the medical record?
A. One Week
B. One Month
C. One Year
D. No time limit - Precise Answer ✔✔D. No time limit
When should a ABN be signed?
A. Prior to performing a statutorily excluded procedure for a Medicare beneficiary.
B. Prior to performing a procedure that may be denied due to medical necessity for a Medicare
beneficiary.
C. Prior to submitting a claim to Medicaid for a non- service.
D. After performing a procedure and finding it is denied. - Precise Answer ✔✔B. Prior to
performing a procedure that may be denied due to medical necessity for a Medicare beneficiary.
Under a Corporate Integrity Agreement (CIA), how many claims must be randomly selected to
review to determine the financial error rate?
A. 15
B. 50
C. 75
D. 100 - Precise Answer ✔✔B. 50
When using LCDs and CMS program Guidance as a resource for an audit, what should the
auditor keep in mind?
A. QICs are bound by NCDs, LMRPs, and CMS Program guidance, but ALJs and MACs are not.
, B. Local carriers and QICs are bound by LCDs and LMRPs
C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs, ALJs, and MACs are
not bound by them.
D. Local Carriers, QICs, ALJs, and MACs are all bound by NCDs and CMS program guidance. -
Precise Answer ✔✔C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs,
ALJs, and MACs are not bound by them.
When reporting the claims review findings under a CIA audit, the Independent Review
Organization (IRO) must provide:
A. A detailed analysis listing the patient files reviewed and findings and previous audit
disclosures for all services
B. A detailed report with a narrative explanation of finding and supporting rationale approved
by the providers attorney.
C. A detailed report with an analysis and narrative explanation with findings and supporting
rationale regarding the claim review, including the results of the discovery or full sample.
D. A list of data reviewed and findings in a narrative form - Precise Answer ✔✔C. A detailed
report with an analysis and narrative explanation with findings and supporting rationale
regarding the claim review, including the results of the discovery or full sample.
Which statement is most accurate regarding NCCI?
A. NCCI are national coding guidelines and must be followed regardless of the insurance carrier.
B. You need to check individual carriers to see if they follow NCCI or if they have their own set
of bundling edits.
C. Each individual carrier will have its own bundling edits and will not use NCCI.
D. NCCI edits are suggested ways to bundle procedure codes, but are not necessary to review
during an audit. - Precise Answer ✔✔B. You need to check individual carriers to see if they
follow NCCI or if they have their own set of bundling edits.
A provider request you to perform an audit of claims that have been denied payment by XYZ
insurance. Since the physician contracted with XYZ insurance, all claims submitted that include
the E/M service and EKG interpretation on the same day have been denied for the EKG
interpretation. You review the medical record and the EOB and determine the services are
documented and coded correctly. Which of the following items will you need to complete your
audit?
A. Provider contract with XYZ insurance.
B. Provider internal billing polices.
ACCURATE QUESTIONS & ANSWERS
The Joint Commission (JC) requires the Factors that Affect Learning must be assessed for a
hospital or hospital owned physician practice as well as other health care facilities. When
assessing this element what does this include?
A. The patient's ability to read, method of learning and understanding.
B. Any language or physical disabilities.
C. Cultural beliefs.
D. All the above - Precise Answer ✔✔D. All the above
Report copies and printouts, films, scans, and other radio logic service image records must be
retained for how long according to Federal Regulations?
A. 10 years
B. 7 years
C. 5 years
D. 3 years - Precise Answer ✔✔C. 5 years
At which point should a provider repay over payments reported by self-disclosure to the office
of Inspector General?
A. Make the payment to your carrier immediately.
B. Make the payment at the conclusion of the OIG injury.
C. Make the payment to the carrier prior to the self disclosure.
D. Make the payment to the OIG with a self disclosure report. - Precise Answer ✔✔B. Make the
payment at the conclusion of the OIG injury
Which of the following may be considered essential element (s) of an operative report and will
allow for accurate coding?
A. The approach
B. The type of anesthesia required
C. The location and severity of wounds repaired
D. All of the above - Precise Answer ✔✔D. All of the above
,Which of the following is NOT a covered entity under HIPPA?
A. Physician
B. Health Plan
C. Health Care Consultant
D. Physician Assistant - Precise Answer ✔✔C. Health Care Consultant
When referring to the authentication of a medical record entry, what does this entail?
A. Legible signature of author and date signed
B. A physician's order for ancillary services
C. An original document filed in the record
D. The patient's personal information - Precise Answer ✔✔A. Legible signature of author and
date signed
What is the time limit mandated by CMS for adding a late entry to the medical record?
A. One Week
B. One Month
C. One Year
D. No time limit - Precise Answer ✔✔D. No time limit
When should a ABN be signed?
A. Prior to performing a statutorily excluded procedure for a Medicare beneficiary.
B. Prior to performing a procedure that may be denied due to medical necessity for a Medicare
beneficiary.
C. Prior to submitting a claim to Medicaid for a non- service.
D. After performing a procedure and finding it is denied. - Precise Answer ✔✔B. Prior to
performing a procedure that may be denied due to medical necessity for a Medicare beneficiary.
Under a Corporate Integrity Agreement (CIA), how many claims must be randomly selected to
review to determine the financial error rate?
A. 15
B. 50
C. 75
D. 100 - Precise Answer ✔✔B. 50
When using LCDs and CMS program Guidance as a resource for an audit, what should the
auditor keep in mind?
A. QICs are bound by NCDs, LMRPs, and CMS Program guidance, but ALJs and MACs are not.
, B. Local carriers and QICs are bound by LCDs and LMRPs
C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs, ALJs, and MACs are
not bound by them.
D. Local Carriers, QICs, ALJs, and MACs are all bound by NCDs and CMS program guidance. -
Precise Answer ✔✔C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs,
ALJs, and MACs are not bound by them.
When reporting the claims review findings under a CIA audit, the Independent Review
Organization (IRO) must provide:
A. A detailed analysis listing the patient files reviewed and findings and previous audit
disclosures for all services
B. A detailed report with a narrative explanation of finding and supporting rationale approved
by the providers attorney.
C. A detailed report with an analysis and narrative explanation with findings and supporting
rationale regarding the claim review, including the results of the discovery or full sample.
D. A list of data reviewed and findings in a narrative form - Precise Answer ✔✔C. A detailed
report with an analysis and narrative explanation with findings and supporting rationale
regarding the claim review, including the results of the discovery or full sample.
Which statement is most accurate regarding NCCI?
A. NCCI are national coding guidelines and must be followed regardless of the insurance carrier.
B. You need to check individual carriers to see if they follow NCCI or if they have their own set
of bundling edits.
C. Each individual carrier will have its own bundling edits and will not use NCCI.
D. NCCI edits are suggested ways to bundle procedure codes, but are not necessary to review
during an audit. - Precise Answer ✔✔B. You need to check individual carriers to see if they
follow NCCI or if they have their own set of bundling edits.
A provider request you to perform an audit of claims that have been denied payment by XYZ
insurance. Since the physician contracted with XYZ insurance, all claims submitted that include
the E/M service and EKG interpretation on the same day have been denied for the EKG
interpretation. You review the medical record and the EOB and determine the services are
documented and coded correctly. Which of the following items will you need to complete your
audit?
A. Provider contract with XYZ insurance.
B. Provider internal billing polices.
