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CPMA Exam Prep Chapter 1 With Correct Questions And Answer 2024
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CPMA Exam Prep Chapter 1 With Correct Questions And Answer 2024
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CPMA Exam Prep Chapter 1 With CorrectQuestions And Answer 2024
12.1% d- dcorrect danswer.# dof dimproper dMedicare dFee-For-Service dclaim dpayments,
daccording dto dFederal dGovernment.
FFS d- dcorrect danswer.Fee-For-Service
Prepayment dReview d- dcorrect danswer.Review dof dclaims dprior dto dpayment. dPrepayment
dreviews dresult din dan dinitial ddetermination.
Postpayment dReview d- dcorrect danswer.Review dof dclaims dafter dpayment. dMay dresult din
deither dno dchange dto dthe dinitial ddetermination dor da drevised ddetermination, dindicating dan
dunderpayment dor doverpayment.
Underpayment d- dcorrect danswer.A dpayment da dprovider dreceives dunder dthe damount ddue
dfor dservices dfurnished dunder dthe dMedicare dstatute dand dregulations.
Overpayment d- dcorrect danswer.A dpayment da dprovider dreceives dover dthe damount ddue dfor
dservices dfurnished dunder dMedicare dstatutes dand dregulations
5 dCommon dreasons dfor doverpayment dare: d- dcorrect danswer.*Billing dfor dexcessive dand
dsubsequent dpayment dof dthe dsame dservice dor dclaim. d
*Duplicate dsubmission dand dpayment dfor dsame dservice dor dclaim
*Payment dfor dexcluded dor dMedically dunnecessary dservices. d
*Payment dfor dservices din dsetting dnot dappropriate dto dpt's dneeds dor dcondition
*Payment dto dan dincorrect dpayee.
MACs d- dcorrect danswer.Medicare dAdministrative dContractors
MAC dResponsibilities d- dcorrect danswer.Process dclaims dfrom dphysicians, dhospitals, dand
dother dhealth dcare dprofessionals, dand dsubmit dpayment dto dthose dproviders daccording dto
dMedicare drules dand dregulations d(including didentifying dunder- dand doverpayments).
ZPICs d- dcorrect danswer.Zone dProgram dIntegrity dContractors
PSCs d- dcorrect danswer.Program dSafeguard dContractor
,ZPICs/PSCs d- dcorrect danswer.Perform dinvestigations dthat dare dunique dand dtailored dto
dspecific dcircumstances dand doccur donly din dsituations dwhere dthere dis dpotential dfraud, dand
dtake dappropriate dcorrective dactions
SMRC d- dcorrect danswer.Supplemental dMedical dReview dContractor
SMRC dResponsibilities d- dcorrect danswer.Conduct dnationwide dmedical dreview das
ddirected dby dCMS d(includes didentifying dunderpayments dand doverpayments
Medicare dFFS dRecovery dAuditors d- dcorrect danswer.Review dclaims dto didentify dpotential
dunderpayments dand doverpayments din dMedicare dFFS, das dpart dof dthe dRecovery dAudit
dProgram
Zone d6 d- dcorrect danswer.All dPSCs dtransitioned dto dZPICs dwith dthe dexception dof dZone d6
While dall dcontractors dfocus don da dspecific darea, d- dcorrect danswer.Each dcontractor
dconducting da dclaim dreview dmust dapply dall dMedicare dpolicies dto dthe dclaim dunder dreview.
dAdditionally, donce da dclaim dis dreviewed, da ddifferent dcontractor dshould dnot dreopen dit.
dTherefore, dit dis dimportant dwhen dconducting dclaim dreviews, dcontractors dreview deach
dclaim din dits dentirety.
Claim dReview dPrograms d- dcorrect danswer.There dare d5 dclaim dreview dprograms
NCCI dEdits d- dcorrect danswer.National dCorrect dCoding dInitiative dEditor
NCCI dEdits dare dperformed dby d- dcorrect danswer.Macs, dZPICs, dCERT, dand dMedicare
dFFS
Complexity: dNon-complex
CMS ddeveloped dthe dNCCI dto d- dcorrect danswer.Promote dnational dcorrect dcoding
dmethods dand dto dcontrol dimproper dcoding dthat dleads dto dinappropriate dpayment din
dMedicare dPart dB dclaims. dNCCI dEdits dprevent dimproper dpayments dwhen dincorrect dcode
dcombinations dare dreported. dThe dNCCI dEdits dare dupdated dquarterly.
The dcoding dpolicies dare dbased don dthe dfollowing dcoding dconventions... d- dcorrect
danswer.*American dMedical dAssociation d(AMA) dCurrent dProcedure dTerminology d(CPT)
dManual
*National dand dlocal dMedicare dpolicies dand dedits
*Coding dguidelines ddeveloped dby dthe dNational dsocieties, dstandard dmedical dand dsurgical
dpractice, dand dcurrent dcoding dpractice.
PTP d- dcorrect danswer.Procedure-to-Procedure dedits
, Column dOne/Column dTwo dedit dpair d- dcorrect danswer.If da dclaim dcontains dthe dtwo dcodes
dof dan dedit dpair, dthe dColumn dOne dcode dis deligible dfor dpayment, dbut dCMS dwill ddeny dthe
dColumn dTwo dcode
NCCI dedit dpairs dthat dare dboth dappropriate d- dcorrect danswer.If dboth dcodes dare dclinically
dappropriate, dyou dmust dappend dwith dan dappropriate dNCCI-associated dmodifier dto dbe
deligible dfor dpayment.
Medicare dbeneficiaries dand dNCCI dedits d- dcorrect danswer.You dcannot dbill dMedicare
dbeneficiaries dfor dservices ddenied dbased don dNCCI dEdits.
ABN d- dcorrect danswer.Advance dBeneficiary dNotice dof dNoncoverage
ABNs dand dNCCI dedits d- dcorrect danswer.When dthe ddenials dare dbased don dincorrect
dcoding drather dthan dmedical dnecessity, dyou dcannot duse dan dABNS d(Form dCMS-R-131) dto
dseek dpayment dfrom da dMedicare dbeneficiary.
NCCI dedits dand dNotice dof dExclusions dfrom dMedicare dBenefits d- dcorrect danswer.If
ddenials dare dbased don dincorrect dcoding drather dthan da dlegislated dMedicare dbenefit
dexclusion, dyou dcannot duse da d"Notice dof dExclusions dfrom dMedicare dBenefits" dform dto
dseek dpayment dfrom da dMedicare dbeneficiary.
OCE d- dcorrect danswer.Outpatient dCode dEditor dedits
Refer dto dthe dOCE dedits dfor dclaims d- dcorrect danswer.For dall dOutpatient dinstitutional
dproviders
Refer dto dNCCI dEdits dfor d- dcorrect danswer.Physician dservices dunder dthe dMedicare
dPhysician dFee dSchedule d(PFS)
PFS d- dcorrect danswer.Physician dFee dSchedule
While da dnumber dof dthe dNCCI dEdits dare dincluded din dthe dOCE dedits d- dcorrect danswer.The
dOCE dedits dare dnot dused dwithin dthe dMedicare dPFS d(Physician dFee dSchedule).
MUEs d- dcorrect danswer.Medically dUnlikely dEdits
Message dare dperformed dby d- dcorrect danswer.Macs d(noncomplex)
CMS ddeveloped dMUEs dto d- dcorrect danswer.Reduce dthe dpaid dclaim derror drate dfor
dMedicare dPart dB dclaims.
Unlike dNCCI dEdits, dthe dMUEs d- dcorrect danswer.Are dautomated dprepayment dedits
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