When auditing CBC tests for a primary care physician, you review the record and verify
the tests were performed, but there is no order. When you questioned the provider, he
indicates there is a standing order to perform a CBC on every patient. What do you
advise the provider?
a. Standing orders...
cpma
When auditing CBC tests for a primary care physician, you review the record and verify
the tests were performed, but there is no order. When you questioned the provider, he
indicates there is a standing order to perform a CBC on every patient. What do you
advise the provider?
a. Standing orders are acceptable as long as the policy is in writing.
b. Because a CBC a low reimbursed test, this should not trigger an audit.
c. This is standard practice for most offices that perform CBC's on site.
d. This is an audit finding. Standing orders cannot be used in this manner. - ✔️✔️d.
This is an audit finding. Standing orders cannot be used in this manner.
When a provider is excluded under the Exclusions statute, What must he or she do at
the end of the exclusionary period?
a. the provider is automatically reinstated
b. The provider must apply for reinstatement.
c. The provider cannot be reinstated once excluded.
d. The provider must apply for a group provider number. - ✔️✔️b. The provider must
apply for reinstatement
What is CoP?
a. Medicare Conditions of Participation.
b. TriCare's Compliance of Physicians Guidance
c. Medicaid's Coordination of Physician Groups
d. Commercial Programs - ✔️✔️a. Medicare Conditions of Participation
When non-compliance is identified, what does the OIG recommended?
a .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.
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 non-compliance,regardless
of the severity of the offense,document the date of the termination,file a corrected claim
on all claims affected.
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
A provider consistently charges a higher level E/M service than is documented to help
cover the cost of his declining practice. Would this be fraud or abuse Why?
a. Abuse,charging one level higher on each visits does not show intent.
b. Abuse; the provider's practice is common and therefore would not be considered
fraudulent .
c. Fraud; and over-coding of services would be considered fraudulent.
d. Fraud; the provider intentionally over-coded to gain financially. - ✔️✔️d. Fraud; the
provider intentionally over-coded to gain financially.
The OIG lists potential risk areas for individual and small physician groups in the
compliance plan guidance. Which option below is listed as a risk area?
a. Unbundling
b. Under Coding
c. Overuse of E/M codes
d. Failure to follow the "same day" rule - ✔️✔️a. Unbundling
The FCA allows for reduced penalties if the person in violation self-discloses if which
conditions exist?
a. The person furnishes all information about the violation with in 30 days after which
the defendant first obtained the information.
b. The person fully cooperates with the investigation.
c. There is no additional criminal prosecution, civil action, or administrated action with
the respect to the violation.
d. All of the above - ✔️✔️d. All of the above
,What is a Qui Tam Relator?
a. a person who is prosecuted under FCA.
b. The defendant in a Stark Law case.
c. a person listed on the OIG exclusions list.
d. a person who brings civil action for violation under the FCA for themselves and the
government. - ✔️✔️d. a person who brings civil action for violation under the FCA for
themselves and the government.
.
Which option is considered a material breach of CIA?
a. Failure to engage and use an IRO in accordance with the CIA.
b. Failure to hire an OIG employee to oversee compliance efforts.
c. Failure to hire a full-time internal auditor to review every claim before it is submitted.
d. Failure to fire auditors who do not agree with the provider's coding - ✔️✔️a. Failure
to engage and use an IRO in accordance with the CIA.
CMS has two sets of Evaluation and Management Documentations Guidelines , 1995
and 1997. Which set is used by physicians for office visits?
a. 1995 E/M Documentation Guidelines
b. 1997 E/M Documentation Guidelines
c. The practice must choose either the 1995 or 1997 E/M Documentation Guidelines for
the entire practice.
d. The practice may use 1995 or 1997 E/M Documentation Guidelines for each visit;
whichever is most advantageous for that visit. - ✔️✔️d. The practice may use 1995 or
1997 E/M Documentation Guidelines for each visit; whichever is most advantageous for
that visit.
What is a semi-automated review?
a. a review based on electronic data examined form submitted claims .
b. A review based on electronic data examined from submitted claims but electively
supported by medical records sent by the provider.
, c. a review based on complete medical records review due lack of Medical Policy being
in a place
d. a review based on tips sent in from internal informants. - ✔️✔️b. A review based on
electronic data examined from submitted claims but electively supported by medical
records sent by the provider.
Which option is NOT part of the seven elements that should be included in a
compliance plan based on the OIG's recommendations?
a. Conducting effective training and education.
b. Responding promptly to detected offenses and developing corrective action.
c. Identifying employees on the exclusions list .
d. Developing effective lines of communication - ✔️✔️c. Identifying employees on the
exclusions list .
What can a provider do if he or she disagrees with a demand letter sent as a result
Recovery Audit?
a. Submit a discussion period request within 15 days of the date of the demand letter.
b. Submit a discussion period request within 120 days of the date of the demand letter.
c. Submit a request for review to the MAC within 15 days from the date of the demand
letter.
d. Submit a request for review to the MAC within 120 days from the date of the demand
letter. - ✔️✔️a. Submit a discussion period request within 15 days of the date of the
demand letter.
A. Qui Tam Relator may receive what type of award for bringing a case on which the
government intervenes?
a. 10-15 percent of the money recovered
b. 15-25 percent of the money recovered
c. 10-15 percent of the total claim amount
d. 15-25 percent of the total claim amount - ✔️✔️b. 15-25 percent of the money
recovered
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