1 | P a g e | © copyright 2024/2025 | Grade A+
CPMA Questions and Answers
(100% Pass)
In February 2020, an auditor is asked to review 10 records for date of service
12/1/2019 to make sure the claims were paid correctly. Te claims included
code 33010, which was denied on all the claims. Te denial was for an invalid
code. What should the auditor advise the provider?
A. Code 33010 was deleted efective 1/1/2020. Determine the correct new
code and have staf resubmit claims.
B. If documentation supports the service, have the staf contact the carrier to
reprocess the claims. Code 55450 was valid for the date of service billed.
C. Code 33010 was deleted efective 1/1/2020. Tis is a valid denial. Advise the
staf to write of the balance.
D. Code 33010 was efective for the date of service. Advise the staf to add
modifer 59 and resubmit the claim.
Master01 | September, 2024/2025 | Latest update
, 1 | P a g e | © copyright 2024/2025 | Grade A+
✓ B. If documentation supports the service, have the staff contact the
carrier to reprocess the claims. Code 33010 was valid for the date of
service billed.
✓ Rationale: The effective dates of codes are date of service driven. New
CPT® codes become effective January 1st of every year. When
auditing, verify codes based on the codes that were valid during the
date of service.
Recovery auditors may perform two types of reviews. What is an automated
review?
a. Review based solely on the submitted claims and regulatory guidelines. No
medical records are needed.
b. Review based on data and potential human review of a medical record or
other documentation.
c. Medical records are required for the review.
d. Review is based solely on denials received.
Master01 | September, 2024/2025 | Latest update
, 1 | P a g e | © copyright 2024/2025 | Grade A+
✓ a. Review based solely on the submitted claims and regulatory
guidelines. No medical records are needed.
✓ For an automated review, no medical records are needed. Improper
payments are determined based solely on the submitted claims and
regulatory guidelines such as National Coverage Determinations, Local
Coverage Determinations, and the CMS Manuals.
When non-compliance is identified, what does the OIG recommended?
a. Take disciplinary action and document the date of the incident, name of
the person responsible for taking action, the follow-up action taken, and a list
of claims that were affected by the action.
b. Take disciplinary action and document the date of the incident, name of
the reporting party, name of the person responsible for taking action, and the
follow-up action taken.
c. Immediately terminate employment for the party found in non-
compliance, regardless of the severity of the offense, document the date of
the termination, file a corrected claim on all claims affected.
d. Continue to watch the employee in non-compliance until the incidents
meet a federal level before taking action.
Master01 | September, 2024/2025 | Latest update
, 1 | P a g e | © copyright 2024/2025 | Grade A+
✓ b. Take disciplinary action and document the date of the incident,
name of the reporting party, name of the person responsible for taking
action, and the follow-up action taken.
✓ According to the OIG, disciplinary action should be taken based on
the severity of the offense. Disciplinary actions could include oral
warnings, written reprimands, probation, demotions, termination, etc.
The incident should be documented with the date of the incident,
name of the reporting party, name of the person responsible for taking
action, and the follow-up action taken.
In a 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 IROs that can be used for the CIA Review.
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.
Master01 | September, 2024/2025 | Latest update
CPMA Questions and Answers
(100% Pass)
In February 2020, an auditor is asked to review 10 records for date of service
12/1/2019 to make sure the claims were paid correctly. Te claims included
code 33010, which was denied on all the claims. Te denial was for an invalid
code. What should the auditor advise the provider?
A. Code 33010 was deleted efective 1/1/2020. Determine the correct new
code and have staf resubmit claims.
B. If documentation supports the service, have the staf contact the carrier to
reprocess the claims. Code 55450 was valid for the date of service billed.
C. Code 33010 was deleted efective 1/1/2020. Tis is a valid denial. Advise the
staf to write of the balance.
D. Code 33010 was efective for the date of service. Advise the staf to add
modifer 59 and resubmit the claim.
Master01 | September, 2024/2025 | Latest update
, 1 | P a g e | © copyright 2024/2025 | Grade A+
✓ B. If documentation supports the service, have the staff contact the
carrier to reprocess the claims. Code 33010 was valid for the date of
service billed.
✓ Rationale: The effective dates of codes are date of service driven. New
CPT® codes become effective January 1st of every year. When
auditing, verify codes based on the codes that were valid during the
date of service.
Recovery auditors may perform two types of reviews. What is an automated
review?
a. Review based solely on the submitted claims and regulatory guidelines. No
medical records are needed.
b. Review based on data and potential human review of a medical record or
other documentation.
c. Medical records are required for the review.
d. Review is based solely on denials received.
Master01 | September, 2024/2025 | Latest update
, 1 | P a g e | © copyright 2024/2025 | Grade A+
✓ a. Review based solely on the submitted claims and regulatory
guidelines. No medical records are needed.
✓ For an automated review, no medical records are needed. Improper
payments are determined based solely on the submitted claims and
regulatory guidelines such as National Coverage Determinations, Local
Coverage Determinations, and the CMS Manuals.
When non-compliance is identified, what does the OIG recommended?
a. Take disciplinary action and document the date of the incident, name of
the person responsible for taking action, the follow-up action taken, and a list
of claims that were affected by the action.
b. Take disciplinary action and document the date of the incident, name of
the reporting party, name of the person responsible for taking action, and the
follow-up action taken.
c. Immediately terminate employment for the party found in non-
compliance, regardless of the severity of the offense, document the date of
the termination, file a corrected claim on all claims affected.
d. Continue to watch the employee in non-compliance until the incidents
meet a federal level before taking action.
Master01 | September, 2024/2025 | Latest update
, 1 | P a g e | © copyright 2024/2025 | Grade A+
✓ b. Take disciplinary action and document the date of the incident,
name of the reporting party, name of the person responsible for taking
action, and the follow-up action taken.
✓ According to the OIG, disciplinary action should be taken based on
the severity of the offense. Disciplinary actions could include oral
warnings, written reprimands, probation, demotions, termination, etc.
The incident should be documented with the date of the incident,
name of the reporting party, name of the person responsible for taking
action, and the follow-up action taken.
In a 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 IROs that can be used for the CIA Review.
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.
Master01 | September, 2024/2025 | Latest update
