1 | P a g | © copyright Grade
e 2024/2025 | 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. To claims included code 33010, which was denied on all the
claims. To denial was for an invalid code. What should the auditor advise the provider?
A. Code 33010 was deleted effective 1/1/2020. Determine the correct new code and have
staff resubmit claims.
B. If documentation supports the service, have the staff contact the carrier to reprocess
the claims. Code 55450 was valid for the date of service billed.
C. Code 33010 was deleted effective 1/1/2020. Tis is a valid denial. Advise the staff to write
of the balance.
D. Code 33010 was effective for the date of service. Advise the staff to add modifier 59 and
resubmit the claim.
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?
Master01 | September, 2024/2025 | Latest update
,✓
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e 2024/2025 | A+
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.
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 noncompliance, regardless of
the severity of the offense, document the date of the termination, file a corrected claim on all
claims affected.
Master01 | September, 2024/2025 | Latest update
,✓
1 | P a g | © copyright Grade
e 2024/2025 | A+
d. Continue to watch the employee in non-compliance until the incidents meet a federal
level before taking 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.
✓ 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.
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.
✓ The OIG will not endorse any particular IRO, but most CIAs include language that gives the OIG
the opportunity to notify a provider that its choice of IRO is unacceptable within 30 days after
Master01 | September, 2024/2025 | Latest update
, ✓
1 | P a g | © copyright Grade
e 2024/2025 | A+
the OIG receives written notice of the identity of the IRO. If the OIG has concerns regarding the
quality of the review or qualifications or independence of the IRO during the term of the CIA, it
will make the concerns known and may request that the agreement with the IRO be terminated
and another IRO be retained.
What rights does a provider have if he/she disagrees with a demand letter sent by the OIG?
a. The provider can choose to self-disclose once a demand letter has been
received.
b. The provider can send in supporting documentation for the claims to the OIG for review by
certified mail.
c. The provider can only respond to the demand letter with payment.
d. The provider can request a hearing before an ALJ in the HHS.
d. The provider can request a hearing before an ALJ in the HHS.
✓ If the subject receiving a demand letter from the OIG disagrees, he/she can request a hearing
before an administrative law judge (ALJ) in Health and Human Services (HHS).
Which statement is TRUE regarding 1995 and 1997 E/M Documentation Guidelines?
a. The 1995 E/M Documentation Guidelines are more detailed using bullets and shading to
determine levels of exams.
b. The 1995 E/M Documentation Guidelines are never beneficial for
specialists.
Master01 | September, 2024/2025 | Latest update
e 2024/2025 | 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. To claims included code 33010, which was denied on all the
claims. To denial was for an invalid code. What should the auditor advise the provider?
A. Code 33010 was deleted effective 1/1/2020. Determine the correct new code and have
staff resubmit claims.
B. If documentation supports the service, have the staff contact the carrier to reprocess
the claims. Code 55450 was valid for the date of service billed.
C. Code 33010 was deleted effective 1/1/2020. Tis is a valid denial. Advise the staff to write
of the balance.
D. Code 33010 was effective for the date of service. Advise the staff to add modifier 59 and
resubmit the claim.
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?
Master01 | September, 2024/2025 | Latest update
,✓
1 | P a g | © copyright Grade
e 2024/2025 | A+
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.
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 noncompliance, regardless of
the severity of the offense, document the date of the termination, file a corrected claim on all
claims affected.
Master01 | September, 2024/2025 | Latest update
,✓
1 | P a g | © copyright Grade
e 2024/2025 | A+
d. Continue to watch the employee in non-compliance until the incidents meet a federal
level before taking 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.
✓ 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.
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.
✓ The OIG will not endorse any particular IRO, but most CIAs include language that gives the OIG
the opportunity to notify a provider that its choice of IRO is unacceptable within 30 days after
Master01 | September, 2024/2025 | Latest update
, ✓
1 | P a g | © copyright Grade
e 2024/2025 | A+
the OIG receives written notice of the identity of the IRO. If the OIG has concerns regarding the
quality of the review or qualifications or independence of the IRO during the term of the CIA, it
will make the concerns known and may request that the agreement with the IRO be terminated
and another IRO be retained.
What rights does a provider have if he/she disagrees with a demand letter sent by the OIG?
a. The provider can choose to self-disclose once a demand letter has been
received.
b. The provider can send in supporting documentation for the claims to the OIG for review by
certified mail.
c. The provider can only respond to the demand letter with payment.
d. The provider can request a hearing before an ALJ in the HHS.
d. The provider can request a hearing before an ALJ in the HHS.
✓ If the subject receiving a demand letter from the OIG disagrees, he/she can request a hearing
before an administrative law judge (ALJ) in Health and Human Services (HHS).
Which statement is TRUE regarding 1995 and 1997 E/M Documentation Guidelines?
a. The 1995 E/M Documentation Guidelines are more detailed using bullets and shading to
determine levels of exams.
b. The 1995 E/M Documentation Guidelines are never beneficial for
specialists.
Master01 | September, 2024/2025 | Latest update
