CPMA Exam with Correct Answers Rate A+

In the NCCI edits, what does modifier indicator nine represent? A. A modifier is not allowed to bypass the NCCI edits B. A modifier may be used to bypass the edits if the documentation supports the modifier C. Modifiers are not applicable he edits, the NCCI edit is not in effect D. Only modifier 59 can be used to bypass the edit. - c. Modifiers are not applicable he edits, the NCCI edit is not in effect In Corporate Integrity Agreement (CIA) does the OIG specify the Independent Review Organization to be used? A. Yes, the specific IRO will be named in the CIA. B. Yes; the CIA will identify five IRO's that can be used for the CIA . C. No, the OIG does not have any input on the IRO used under any circumstance. D. No; the OIG does not specify the IRO to be used, but does retain the right to notify the provider if they must select a new IRO. - d. No; the OIG does not specify the IRO to be used, but does retain the right to notify the provider if they must select a new IRO. Which of the following best represents an example of fraudulent activity? A. Waiving cost-shares or deductibles. B. A pattern of claims for services not medically necessary. C. Failure to maintain adequate medical or financial records. D. Billing for services at a higher level than provided or necessary. - d. Billing for services at a higher level than provided or necessary. What is the maximum penalty the OIG may seek for fraudulent claims? A. 10,000 per item or service. B. 15,000 per item or service. C.10,000 per item or service plus three times the amount of over-payments. D. 15,000 per item or service plus three times the amount of over-payments. - c.10,000 per item or service plus three times the amount of over-payments. The OIG Work Plan is divided into seven parts. Which option is a part of the OIG work plan most applicable to physician? A. Medicare Part A and Part B B. Public Health Reviews C. Human Services Reviews D. Corporate Integrity Agreements - a. Medicare Part A and Part B You Audit provider who is consistently reporting multiple units of CPT code 11042. What references can you use to show the provider multiple units of CPT code 11042 is not allowed and explain how it should be reported? A. CPT codebook and MUE table. B. CPT codebook and NCCI edits C. MUE table only D. HCPCS codebook and NCCI edits - a. CPT codebook and MUE table