CPMA Review Questions with 100% Correct Answers

ALJ - Administrative law judge OIG - Office of Inspector General CIA - Corporate Integrity Agreement IRO - Independent Review Organization HHS - Health and Human Services LEIE - List of Excluded Individuals /Entities CMPL - Civil Monetary Penalties Law NIH - National Institute of Health SOAP - Subjective, Objective, Assessment, Plan 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 the medical records? - Patient ID, assignment of benefits, pt's medical hx, immunizations, physical examination, lab report, clinical impression & physician orders. When labs are ordered, there must be a copy of the order and the lab report that the physician has reviewed. What is the minimum requirement for the signature of the author of an entry in the medical records? - The first initial, last name and credentials Based on JCAHO accreditation guidance for personal data, what two elements must be evident in the medical records? - Personal biographical data and consent for Treatment or authorization for Treatment form. What is a comprehensive/focus review audit? - A large number of claims are selected for review that might be focused on specific procedure and/or dx codes