HOSMERIT
AAPC CPMA PRACTICE EXAM STUDY QUESTIONS
AND ANSWERS (100% PASS)
What elements must be in a medical record
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?
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?
There must be a patient information sheet that contains biographical data, name, address, etc. along
with authorization for treatment whether it is an office visit, diagnostic services or surgical procedure.
What is the appropriate way to dispose of PHI that is no longer needed?
Discard it in a locked shredding receptacle
When must ABNs be signed?
Far enough in advance that the beneficiary or representative has time to consider the options and
make an informed decision.
, SOAP and CHEDDAR are two formats of medical record documentation. Which section of each
format would you find the patient's history?
S in SOAP and H in CHEDDAR
Patients can request copies of disclosure of PHI under HIPAA:
For a six (6) year period of time
When can a RAC extrapolate the overpayment(s) on claims?
If a RAC can demonstrate a high level of error, the RAC can then extrapolate the findings and
request a refund.
Example: Column 1 Code/Column 2 Code 45385/45380 CPT Code 45385 - Colonoscopy, flexible,
proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
CPT Code 45380 - Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or
multiple Policy: More extensive procedure Modifier -59 is:
Only appropriate if the two procedures are performed on separate lesions or at separate patient
encounters.
AAPC CPMA PRACTICE EXAM STUDY QUESTIONS
AND ANSWERS (100% PASS)
What elements must be in a medical record
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?
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?
There must be a patient information sheet that contains biographical data, name, address, etc. along
with authorization for treatment whether it is an office visit, diagnostic services or surgical procedure.
What is the appropriate way to dispose of PHI that is no longer needed?
Discard it in a locked shredding receptacle
When must ABNs be signed?
Far enough in advance that the beneficiary or representative has time to consider the options and
make an informed decision.
, SOAP and CHEDDAR are two formats of medical record documentation. Which section of each
format would you find the patient's history?
S in SOAP and H in CHEDDAR
Patients can request copies of disclosure of PHI under HIPAA:
For a six (6) year period of time
When can a RAC extrapolate the overpayment(s) on claims?
If a RAC can demonstrate a high level of error, the RAC can then extrapolate the findings and
request a refund.
Example: Column 1 Code/Column 2 Code 45385/45380 CPT Code 45385 - Colonoscopy, flexible,
proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
CPT Code 45380 - Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or
multiple Policy: More extensive procedure Modifier -59 is:
Only appropriate if the two procedures are performed on separate lesions or at separate patient
encounters.
