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Chapter 1 CPMA Exam Prep /155 Questions And Answers Updated
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Chapter 1 CPMA Exam Prep /155 Questions AndAnswers Updated 2023-2024
Quiz :12.1% - Answer :# of improper Medicare Fee-For-Service claim
payments, according to Federal Government.
Quiz :FFS - Answer :Fee-For-Service
Quiz :Prepayment Review - Answer :Review of claims prior to payment.
Prepayment reviews result in an initial determination.
Quiz :Postpayment Review - Answer :Review of claims after payment. May
result in either no change to the initial determination or a revised
determination, indicating an underpayment or overpayment.
Quiz :Underpayment - Answer :A payment a provider receives under the
amount due for services furnished under the Medicare statute and regulations.
Quiz :Overpayment - Answer :A payment a provider receives over the amount
due for services furnished under Medicare statutes and regulations
Quiz :5 Common reasons for overpayment are: - Answer :*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.
Quiz :MACs - Answer :Medicare Administrative Contractors
Quiz :MAC Responsibilities - Answer :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).
Quiz :ZPICs - Answer :Zone Program Integrity Contractors
Quiz :PSCs - Answer :Program Safeguard Contractor
, Quiz :ZPICs/PSCs - Answer :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
Quiz :SMRC - Answer :Supplemental Medical Review Contractor
Quiz :SMRC Responsibilities - Answer :Conduct nationwide medical review as
directed by CMS (includes identifying underpayments and overpayments
Quiz :Medicare FFS Recovery Auditors - Answer :Review claims to identify
potential underpayments and overpayments in Medicare FFS, as part of the
Recovery Audit Program
Quiz :Zone 6 - Answer :All PSCs transitioned to ZPICs with the exception of
Zone 6
Quiz :While all contractors focus on a specific area, - Answer :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.
Quiz :Claim Review Programs - Answer :There are 5 claim review programs
Quiz :NCCI Edits - Answer :National Correct Coding Initiative Editor
Quiz :NCCI Edits are performed by - Answer :Macs, ZPICs, CERT, and Medicare
FFS
Complexity: Non-complex
Quiz :CMS developed the NCCI to - Answer :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.
Quiz :The coding policies are based on the following coding conventions... -
Answer :*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.
Quiz :PTP - Answer :Procedure-to-Procedure edits
Quiz :Column One/Column Two edit pair - Answer :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
Quiz :NCCI edit pairs that are both appropriate - Answer :If both codes are
clinically appropriate, you must append with an appropriate NCCI-associated
modifier to be eligible for payment.
Quiz :Medicare beneficiaries and NCCI edits - Answer :You cannot bill
Medicare beneficiaries for services denied based on NCCI Edits.
Quiz :ABN - Answer :Advance Beneficiary Notice of Noncoverage
Quiz :ABNs and NCCI edits - Answer :When the denials are based on incorrect
coding rather than medical necessity, you cannot use an ABNS (Form CMS-R-
131) to seek payment from a Medicare beneficiary.
Quiz :NCCI edits and Notice of Exclusions from Medicare Benefits - Answer :If
denials are based on incorrect coding rather than a legislated Medicare benefit
exclusion, you cannot use a "Notice of Exclusions from Medicare Benefits"
form to seek payment from a Medicare beneficiary.
Quiz :OCE - Answer :Outpatient Code Editor edits
Quiz :Refer to the OCE edits for claims - Answer :For all Outpatient
institutional providers
Quiz :Refer to NCCI Edits for - Answer :Physician services under the Medicare
Physician Fee Schedule (PFS)
Quiz :PFS - Answer :Physician Fee Schedule
Quiz :While a number of the NCCI Edits are included in the OCE edits - Answer
:The OCE edits are not used within the Medicare PFS (Physician Fee Schedule).
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