CHAPTER 1 CPMA EXAM PREP NEWEST 2026/2027 TEST BANK|CERTIFIED PROFESSIONAL MEDICAL AUDITOR EXAM PREP WITH COMPLETE 200 REAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) ALREADY GRADED A+ (BRAND NEW!!)

CHAPTER 1 CPMA EXAM PREP
NEWEST 2026/2027 TEST
BANK|CERTIFIED PROFESSIONAL
MEDICAL AUDITOR EXAM PREP WITH
COMPLETE 200 REAL EXAM
QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+
(BRAND NEW!!)
12.1%m-mCORRECTmANSWERm#mofmimpropermMedicaremFee-For-
Servicemclaimmpayments,maccordingmtomFederalmGovernment.



FFSm-mCORRECTmANSWERmFee-For-Service



PrepaymentmReviewm-
mCORRECTmANSWERmReviewmofmclaimsmpriormtompayment.mPrepaymentmreviewsmresultminmanminiti


almdetermination.



PostpaymentmReviewm-
mCORRECTmANSWERmReviewmofmclaimsmaftermpayment.mMaymresultminmeithermnomchangemtomthemi


nitialmdeterminationmormamrevisedmdetermination,mindicatingmanmunderpaymentmormoverpayment
.



Underpaymentm-
mCORRECTmANSWERmAmpaymentmamprovidermreceivesmundermthemamountmduemformservicesmfurnis


hedmundermthemMedicaremstatutemandmregulations.

,Overpaymentm-
mCORRECTmANSWERmAmpaymentmamprovidermreceivesmovermthemamountmduemformservicesmfurnish


edmundermMedicaremstatutesmandmregulations



5mCommonmreasonsmformoverpaymentmare:m-
mCORRECTmANSWERm*Billingmformexcessivemandmsubsequentmpaymentmofmthemsamemservicemormcl


aim.m

*Duplicatemsubmissionmandmpaymentmformsamemservicemormclaim

*PaymentmformexcludedmormMedicallymunnecessarymservices.m

*Paymentmformservicesminmsettingmnotmappropriatemtompt'smneedsmormcondition

*Paymentmtomanmincorrectmpayee.



MACsm-mCORRECTmANSWERmMedicaremAdministrativemContractors



MACmResponsibilitiesm-
mCORRECTmANSWERmProcessmclaimsmfrommphysicians,mhospitals,mandmothermhealthmcaremprofessi


onals,mandmsubmitmpaymentmtomthosemprovidersmaccordingmtomMedicaremrulesmandmregulationsm(i
ncludingmidentifyingmunder-mandmoverpayments).



ZPICsm-mCORRECTmANSWERmZonemProgrammIntegritymContractors



PSCsm-mCORRECTmANSWERmProgrammSafeguardmContractor



ZPICs/PSCsm-
mCORRECTmANSWERmPerformminvestigationsmthatmaremuniquemandmtailoredmtomspecificmcircumsta


ncesmandmoccurmonlyminmsituationsmwheremtheremismpotentialmfraud,mandmtakemappropriatemcorrec
tivemactions



SMRCm-mCORRECTmANSWERmSupplementalmMedicalmReviewmContractor

, SMRCmResponsibilitiesm-
mCORRECTmANSWERmConductmnationwidemmedicalmreviewmasmdirectedmbymCMSm(includesmidentif


yingmunderpaymentsmandmoverpayments



MedicaremFFSmRecoverymAuditorsm-
mCORRECTmANSWERmReviewmclaimsmtomidentifympotentialmunderpaymentsmandmoverpaymentsmin


mMedicaremFFS,masmpartmofmthemRecoverymAuditmProgram




Zonem6m-mCORRECTmANSWERmAllmPSCsmtransitionedmtomZPICsmwithmthemexceptionmofmZonem6



Whilemallmcontractorsmfocusmonmamspecificmarea,m-
mCORRECTmANSWERmEachmcontractormconductingmamclaimmreviewmmustmapplymallmMedicarempolic


iesmtomthemclaimmundermreview.mAdditionally,moncemamclaimmismreviewed,mamdifferentmcontractorms
houldmnotmreopenmit.mTherefore,mitmismimportantmwhenmconductingmclaimmreviews,mcontractorsmre
viewmeachmclaimminmitsmentirety.



ClaimmReviewmProgramsm-mCORRECTmANSWERmTheremarem5mclaimmreviewmprograms



NCCImEditsm-mCORRECTmANSWERmNationalmCorrectmCodingmInitiativemEditor



NCCImEditsmaremperformedmbym-mCORRECTmANSWERmMacs,mZPICs,mCERT,mandmMedicaremFFS



Complexity:mNon-complex



CMSmdevelopedmthemNCCImtom-
mCORRECTmANSWERmPromotemnationalmcorrectmcodingmmethodsmandmtomcontrolmimpropermcodin


gmthatmleadsmtominappropriatempaymentminmMedicaremPartmBmclaims.mNCCImEditsmpreventmimprope
rmpaymentsmwhenmincorrectmcodemcombinationsmaremreported.mThemNCCImEditsmaremupdatedmqua
rterly.