CPMA EXAM CHAPTER 1 PREP QUESTIONS AND
100% CORRECT ANSWERS (2025)
12.1% - CORRECT ANSWERV - # of improper Medicare Fee-For-
Service claim payments, according to Federal Government.
FFS - CORRECT ANSWERV - Fee-For-Service
Overpayment - CORRECT ANSWERV - A payment a provider receives
over the amount due for services furnished under Medicare statutes and
regulations
5 Common reasons for overpayment are: - CORRECT ANSWERV -
*Billing for excessive and subsequent payment of the same service or
claim.
*Duplicate submission and payment for same service or claim
*Payment for excluded or Medically unnecessary services.
*Payment for services in setting not appropriate to pt's needs or
condition
*Payment to an incorrect payee.
MACs - CORRECT ANSWERV - Medicare Administrative Contractors
MAC Responsibilities - CORRECT ANSWERV - Process claims from
physicians, hospitals, and other health care professionals, and submit
payment to those providers according to Medicare rules and regulations
(including identifying under- and overpayments).
ZPICs - CORRECT ANSWERV - Zone Program Integrity Contractors
PSCs - CORRECT ANSWERV - Program Safeguard Contractor
,ZPICs/PSCs - CORRECT ANSWERV - Perform investigations that are
unique and tailored to specific circumstances and occur only in
situations where there is potential fraud, and take appropriate corrective
actions
SMRC - CORRECT ANSWERV - Supplemental Medical Review
Contractor
SMRC Responsibilities - CORRECT ANSWERV - Conduct nationwide
medical review as directed by CMS (includes identifying underpayments
and overpayments
Medicare FFS Recovery Auditors - CORRECT ANSWERV - Review
claims to identify potential underpayments and overpayments in
Medicare FFS, as part of the Recovery Audit Program
Zone 6 - CORRECT ANSWERV - All PSCs transitioned to ZPICs with
the exception of Zone 6
While all contractors focus on a specific area, - CORRECT ANSWERV
- Each contractor conducting a claim review must apply all Medicare
policies to the claim under review. Additionally, once a claim is
reviewed, a different contractor should not reopen it. Therefore, it is
important when conducting claim reviews, contractors review each
claim in its entirety.
Claim Review Programs - CORRECT ANSWERV - There are 5 claim
review programs
NCCI Edits - CORRECT ANSWERV - National Correct Coding
Initiative Editor
NCCI Edits are performed by - CORRECT ANSWERV - Macs, ZPICs,
CERT, and Medicare FFS
, Complexity: Non-complex
CMS developed the NCCI to - CORRECT ANSWERV - Promote
national correct coding methods and to control improper coding that
leads to inappropriate payment in Medicare Part B claims. NCCI Edits
prevent improper payments when incorrect code combinations are
reported. The NCCI Edits are updated quarterly.
The coding policies are based on the following coding conventions... -
CORRECT ANSWERV - *American Medical Association (AMA)
Current Procedure Terminology (CPT) Manual
*National and local Medicare policies and edits
*Coding guidelines developed by the National societies, standard
medical and surgical practice, and current coding practice.
PTP - CORRECT ANSWERV - Procedure-to-Procedure edits
Column One/Column Two edit pair - CORRECT ANSWERV - If a
claim contains the two codes of an edit pair, the Column One code is
eligible for payment, but CMS will deny the Column Two code
NCCI edit pairs that are both appropriate - CORRECT ANSWERV - If
both codes are clinically appropriate, you must append with an
appropriate NCCI-associated modifier to be eligible for payment.
Medicare beneficiaries and NCCI edits - CORRECT ANSWERV - You
cannot bill Medicare beneficiaries for services denied based on NCCI
Edits.
ABN - CORRECT ANSWERV - Advance Beneficiary Notice of
Noncoverage
ABNs and NCCI edits - CORRECT ANSWERV - When the denials are
based on incorrect coding rather than medical necessity, you cannot use
100% CORRECT ANSWERS (2025)
12.1% - CORRECT ANSWERV - # of improper Medicare Fee-For-
Service claim payments, according to Federal Government.
FFS - CORRECT ANSWERV - Fee-For-Service
Overpayment - CORRECT ANSWERV - A payment a provider receives
over the amount due for services furnished under Medicare statutes and
regulations
5 Common reasons for overpayment are: - CORRECT ANSWERV -
*Billing for excessive and subsequent payment of the same service or
claim.
*Duplicate submission and payment for same service or claim
*Payment for excluded or Medically unnecessary services.
*Payment for services in setting not appropriate to pt's needs or
condition
*Payment to an incorrect payee.
MACs - CORRECT ANSWERV - Medicare Administrative Contractors
MAC Responsibilities - CORRECT ANSWERV - Process claims from
physicians, hospitals, and other health care professionals, and submit
payment to those providers according to Medicare rules and regulations
(including identifying under- and overpayments).
ZPICs - CORRECT ANSWERV - Zone Program Integrity Contractors
PSCs - CORRECT ANSWERV - Program Safeguard Contractor
,ZPICs/PSCs - CORRECT ANSWERV - Perform investigations that are
unique and tailored to specific circumstances and occur only in
situations where there is potential fraud, and take appropriate corrective
actions
SMRC - CORRECT ANSWERV - Supplemental Medical Review
Contractor
SMRC Responsibilities - CORRECT ANSWERV - Conduct nationwide
medical review as directed by CMS (includes identifying underpayments
and overpayments
Medicare FFS Recovery Auditors - CORRECT ANSWERV - Review
claims to identify potential underpayments and overpayments in
Medicare FFS, as part of the Recovery Audit Program
Zone 6 - CORRECT ANSWERV - All PSCs transitioned to ZPICs with
the exception of Zone 6
While all contractors focus on a specific area, - CORRECT ANSWERV
- Each contractor conducting a claim review must apply all Medicare
policies to the claim under review. Additionally, once a claim is
reviewed, a different contractor should not reopen it. Therefore, it is
important when conducting claim reviews, contractors review each
claim in its entirety.
Claim Review Programs - CORRECT ANSWERV - There are 5 claim
review programs
NCCI Edits - CORRECT ANSWERV - National Correct Coding
Initiative Editor
NCCI Edits are performed by - CORRECT ANSWERV - Macs, ZPICs,
CERT, and Medicare FFS
, Complexity: Non-complex
CMS developed the NCCI to - CORRECT ANSWERV - Promote
national correct coding methods and to control improper coding that
leads to inappropriate payment in Medicare Part B claims. NCCI Edits
prevent improper payments when incorrect code combinations are
reported. The NCCI Edits are updated quarterly.
The coding policies are based on the following coding conventions... -
CORRECT ANSWERV - *American Medical Association (AMA)
Current Procedure Terminology (CPT) Manual
*National and local Medicare policies and edits
*Coding guidelines developed by the National societies, standard
medical and surgical practice, and current coding practice.
PTP - CORRECT ANSWERV - Procedure-to-Procedure edits
Column One/Column Two edit pair - CORRECT ANSWERV - If a
claim contains the two codes of an edit pair, the Column One code is
eligible for payment, but CMS will deny the Column Two code
NCCI edit pairs that are both appropriate - CORRECT ANSWERV - If
both codes are clinically appropriate, you must append with an
appropriate NCCI-associated modifier to be eligible for payment.
Medicare beneficiaries and NCCI edits - CORRECT ANSWERV - You
cannot bill Medicare beneficiaries for services denied based on NCCI
Edits.
ABN - CORRECT ANSWERV - Advance Beneficiary Notice of
Noncoverage
ABNs and NCCI edits - CORRECT ANSWERV - When the denials are
based on incorrect coding rather than medical necessity, you cannot use
