CPMA Questions with Correct
Answers Graded A+
Under CIA, 50 sampling units are reviewed. What is the sample referred as?
A. Discovery Sample
B. Initial Sample
C. Complete Sample
D. Selective Sample A. Discovery Sample
(used to determine the net financial error rate)
Which may result in fal...
Under CIA, 50 sampling units are reviewed. What is the sample referred as?
A. Discovery Sample
B. Initial Sample
C. Complete Sample
D. Selective Sample ✔✔A. Discovery Sample
(used to determine the net financial error rate)
Which may result in false claims act violation?
A. A provider routinely waives the copay for MCR beneficiaries
B. A provider accepts insurance only payments from MCR beneficiaries
C. A provider submits claims to MCR for DME supplies not provided to MCR beneficiaries
D. A provider knowingly submits claims to MCR for DME supplies not provided MCR
beneficiaries ✔✔D. A provider knowingly submits claims to MCR for DME supplies not
provided MCR beneficiaries
A Qui Tam Relator may receive what type of award for bringing a case in which the government
intervenes?
A. 15-25% of money recovered
B. 10-15% of money recovered
C. 10-15% of total claim amount
D. 15-40% of total claim amount ✔✔A. 15-25% of money recovered
What is the look back period for FFS Recovery Auditors reviewing claims?
A. 60 days
B. 5 years
C. 15 year
,D. 3 years ✔✔D. 3 years
The OIG lists potential risk areas for physician groups in the compliance plan guidance. Which
option is listed as a risk area?
A. Under Coding
B. Unbundling
C. Overuse of E/M Codes
D. Failure to follow the same-day rule ✔✔B. Unbundling
In the NCCI edits, what does modifier indicator zero (0) represent?
A. Modifiers are not applicable to the edits
B. The NCCI edit is not in effect
C. A modifier may not be used to bypass the edits if the documentation supports the modifier
D. A modifier is not allowed to bypass the NCCI edits ✔✔D. A modifier is not allowed to
bypass the NCCI edits
What can a provider do if he or she disagrees with a demand letter sent as a result of a recovery
audit?
A. Submit a request for review to the MAC within 120 days from the date of the demand letter
B. Submit a request for review to the MAC within 15 days from the date of the demand letter
C. Submit a discussion period request within 120 days of the date of the demand letter
D. Submit a discussion period request within 30 days of the date of the demand letter ✔✔D.
Submit a discussion period request within 30 days of the date of the demand letter
Which of the following best represents an example of fraud?
A. Billing for services at a higher level than provided or necessary
B. Waiving cost-shares or deductibles
C. A pattern of claims for services not medically necessary
D. Failure to maintain adequate medical or financial records ✔✔A. Billing for services at a
higher level than provided or necessary
,When a physician is banned from participating in any Federal or State health care program by the
OIG under the Exclusion Statue, what is the minimum term of exclusion applies?
A. 10 years
B. 5 Years
C. 60 Days
D. 1 year ✔✔B. 5 Years
Which of the following actions is an example of fraud or misconduct subject to the False Claims
act?
A. The provider receives a lab result back and documents in the patient's chart that the lab result
indicates a malignant lesion
B. The provider alters all medical records for lesion excisions to support the level he reported on
the claim
C. The provider determines he has forgotten to document the size of the one lesion and makes an
addendum
D. The provider reviews his records and determines the documentation supports the calims.
✔✔B. The provider alters all medical records for lesion excisions to support the level he reported
on the claim
You Audit 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 is not allowed and
explain how it should be reported ?
a. CPT codebook and MUE table.
b. CPT codebook and NCCI edits
c. MUE table only
d. HCPCS codebook and NCCI edits ✔✔a. CPT codebook and MUE table.
, The OIG Compliance Program Guidance for individual and small group identifies 4 risk areas
affecting physicians.
A. Coding and billing, reasonable and necessary services, documentation, and improper
inducements, kickbacks and self referrals.
B. Claims submission, background checks, HIPAA violations, audit compliance
C. Coding and billing, background checks, documentation, improper inducements, kickbacks and
self-referrals
D. Clams submission, HIPAA violations, audit compliance, improper inducements, kickbacks
and self referrals ✔✔A. Coding and billing, reasonable and necessary services, documentation,
and improper inducements, kickbacks and self referrals.
What is another name for the Federal False Clams Act (FCA)?
A. Stark Law
B. Operation Restore Trust
C. Lincoln Law
D. Kennedy-Kassebaum Law ✔✔C. Lincoln Law
What is a Qui Tam Realtor?
A. The defendant in a Qui Tam Case
B. The employer of the defendant in the Qui Tam Case
C. A person assigned to investigate accusations of fraudulent billing
D. A person who brings a civil action for a violation for him/herself and for the US government
✔✔D. A person who brings a civil action for a violation for him/herself and for the US
government
When a IRO is completing a CIA Discovery Sample, how many sampling units are reviewed?
A. 200
B. 100
C. 50
D. 10 ✔✔C. 50
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