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CPMA New 2023-2024 /Questions And Answers 100%Score!!!
Answer :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. - Quiz :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. Te claims included
code 33010, which was denied on all the claims. Te denial was for an invalid
code. What should the auditor advise the provider?
A. Code 33010 was deleted efective 1/1/2020. Determine the correct new
code and have staf resubmit claims.
B. If documentation supports the service, have the staf contact the carrier to
reprocess the claims. Code 55450 was valid for the date of service billed.
C. Code 33010 was deleted efective 1/1/2020. Tis is a valid denial. Advise the
staf to write of the balance.
D. Code 33010 was efective for the date of service. Advise the staf to add
modifer 59 and resubmit the claim.
Answer :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. - Quiz :Recovery auditors may perform two types of
reviews. What is an automated review?
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.
Answer :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. -
Quiz :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 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.
Answer :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 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. - Quiz :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.
Answer :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). - Quiz :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.
Answer :d. The 1997 E/M Documentation Guidelines are more detailed using
bullets and shading to determine levels of exams.
The 1995 E/M Documentation Guidelines are vague in the description of the
exam whereas the 1997 E/M Documentation Guidelines are more detailed
using bullets and shading to determine levels of exams. - Quiz :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.
c. The 1997 E/M Documentation Guidelines are never beneficial for general
practitioners.
d. The 1997 E/M Documentation Guidelines are more detailed using bullets
and shading to determine levels of exams.
Answer :b. Hire an OIG employee to oversee the compliance efforts
A comprehensive CIA typically lasts 5 years and includes requirements to:
· hire a compliance officer/appoint a compliance committee;
· develop written standards and policies;
· implement a comprehensive employee training program;
· retain an independent review organization to conduct annual reviews;
· establish a confidential disclosure program;
· restrict employment of ineligible persons;
· report overpayments, reportable events, and ongoing investigations/legal
proceedings; and
· provide an implementation report and annual reports to OIG on the status of
the entity's compliance activities. - Quiz :A Corporate Integrity Agreement
(CIA) has core requirements. Which option is NOT one of the core
requirements?
a. Provide an implementation report and annual reports to OIG on the status
of the entity's compliance activities.
b. Hire an OIG employee to oversee the compliance efforts.
, c. Develop written standards and policies.
d. Restrict employment of ineligible persons.
Answer :a. OIG Work Plan
Rationale: The HHS OIG publishes its Work Plan on its website that lists the
various projects, which are or will be addressed by the Office of Audit Services,
Office of Evaluation and Inspections, Office of Investigations, and Office of
Counsel to the Inspector General. - Quiz :Which OIG publication identifies
various projects that are and will be addressed by the Office of Audit Services,
Office of Evaluation and Inspections, Office of Investigations, and Office of
Counsel to the Inspector General?
a. OIG Work Plan
b. Semiannual Report to Congress
c. Compendium of Unimplemented Recommendations
d. OIG Compliance Plan Guidance
Answer :b. The provider must apply for reinstatement.
When the exclusionary period has ended, the individual or entity must apply
for reinstatement and receive authorized notice from OIG that reinstatement
has been granted. - Quiz :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.
Answer :a. CPT codebook and MUE (Medical Unlikely Edits) table. - Quiz :You
audit a provider who is consistently reporting multiple units of CPT code
11042. What references can you use to show the provider multiple units of CPT
code 11042 are not allowed and explain how it should be reported?
a. CPT codebook and MUE (Medical Unlikely Edits) table.
b. CPT codebook and NCCI procedure-to-procedure (PTP) edits.
c. MUE table only.
d. HCPCS codebook and NCCI procedure-to-procedure (PTP) edits.
Answer :c. Lincoln Law
Also called the Lincoln Law, the False Claims Act (31 U.S.C. §§ 3729 - 3733) was
enacted in 1863 to combat fraud by suppliers of goods to the Union Army
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