CPMA EXAM QUESTIONS AND 100% CORRECT
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 - 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 - 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. - 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 - 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 - 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 - 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 - 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. - 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 - 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. - 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 - 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. - 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.
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 - 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 - 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. - 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 - 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 - 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 - 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 - 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. - 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 - 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. - 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 - 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. - 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.
