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CPMA Exam With Correct Explained Questions And Answers 2024
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CPMA Exam With Correct Explained Questions And Answers 2024
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CPMA Exam With Correct ExplainedQuestions And Answers 2024
In uFebruary u2020, uan uauditor uis uasked uto ureview u10 urecords ufor udate uof uservice
u12/1/2019 uto umake usure uthe uclaims uwere upaid ucorrectly. uTe uclaims uincluded ucode
u33010, uwhich uwas udenied uon uall uthe uclaims. uTe udenial uwas ufor uan uinvalid ucode. uWhat
ushould uthe uauditor uadvise uthe uprovider?
A. uCode u33010 uwas udeleted uefective u1/1/2020. uDetermine uthe ucorrect unew ucode uand
uhave ustaf uresubmit uclaims.
B. uIf udocumentation usupports uthe uservice, uhave uthe ustaf ucontact uthe ucarrier uto
ureprocess uthe uclaims. uCode u55450 uwas uvalid ufor uthe udate uof uservice ubilled.
C. uCode u33010 uwas udeleted uefective u1/1/2020. uTis uis ua uvalid udenial. uAdvise uthe ustaf uto
uwrite uof uthe ubalance.
D. uCode u33010 uwas uefective ufor uthe udate uof uservice. uAdvise uthe ustaf uto uadd umodifer u59
uand uresubmit uthe uclaim. u- ucorrect uanswer.B. uIf udocumentation usupports uthe uservice,
uhave uthe ustaff ucontact uthe ucarrier uto ureprocess uthe uclaims. uCode u33010 uwas uvalid ufor
uthe udate uof uservice ubilled.
Rationale: uThe ueffective udates uof ucodes uare udate uof uservice udriven. uNew uCPT® ucodes
ubecome ueffective uJanuary u1st uof uevery uyear. uWhen uauditing, uverify ucodes ubased uon
uthe ucodes uthat uwere uvalid uduring uthe udate uof uservice.
Recovery uauditors umay uperform utwo utypes uof ureviews. uWhat uis uan uautomated ureview?
a. uReview ubased usolely uon uthe usubmitted uclaims uand uregulatory uguidelines. uNo umedical
urecords uare uneeded.
b. uReview ubased uon udata uand upotential uhuman ureview uof ua umedical urecord uor uother
udocumentation.
c. uMedical urecords uare urequired ufor uthe ureview.
d. uReview uis ubased usolely uon udenials ureceived. u- ucorrect uanswer.a. uReview ubased
usolely uon uthe usubmitted uclaims uand uregulatory uguidelines. uNo umedical urecords uare
uneeded.
For uan uautomated ureview, uno umedical urecords uare uneeded. uImproper upayments uare
udetermined ubased usolely uon uthe usubmitted uclaims uand uregulatory uguidelines usuch uas
uNational uCoverage uDeterminations, uLocal uCoverage uDeterminations, uand uthe uCMS
uManuals.
When unon-compliance uis uidentified, uwhat udoes uthe uOIG urecommended?
,a. uTake udisciplinary uaction uand udocument uthe udate uof uthe uincident, uname uof uthe uperson
uresponsible ufor utaking uaction, uthe ufollow-up uaction utaken, uand ua ulist uof uclaims uthat uwere
uaffected uby uthe uaction.
b. uTake udisciplinary uaction uand udocument uthe udate uof uthe uincident, uname uof uthe
ureporting uparty, uname uof uthe uperson uresponsible ufor utaking uaction, uand uthe ufollow-up
uaction utaken.
c. uImmediately uterminate uemployment ufor uthe uparty ufound uin unon-compliance,
uregardless uof uthe useverity uof uthe uoffense, udocument uthe udate uof uthe utermination, ufile ua
ucorrected uclaim uon uall uclaims uaffected.
d. uContinue uto uwatch uthe uemployee uin unon-compliance uuntil uthe uincidents umeet ua
ufederal ulevel ubefore utaking uaction. u- ucorrect uanswer.b. uTake udisciplinary uaction uand
udocument uthe udate uof uthe uincident, uname uof uthe ureporting uparty, uname uof uthe uperson
uresponsible ufor utaking uaction, uand uthe ufollow-up uaction utaken.
According uto uthe uOIG, udisciplinary uaction ushould ube utaken ubased uon uthe useverity uof uthe
uoffense. uDisciplinary uactions ucould uinclude uoral uwarnings, uwritten ureprimands,
uprobation, udemotions, utermination, uetc. uThe uincident ushould ube udocumented uwith uthe
udate uof uthe uincident, uname uof uthe ureporting uparty, uname uof uthe uperson uresponsible ufor
utaking uaction, uand uthe ufollow-up uaction utaken.
In ua uCorporate uIntegrity uAgreement u(CIA), udoes uthe uOIG uspecify uthe uIndependent
uReview uOrganization uto ube uused?
a. uYes; uthe uspecific uIRO uwill ube unamed uin uthe uCIA.
b. uYes; uthe uCIA uwill uidentify ufive uIROs uthat ucan ube uused ufor uthe uCIA uReview.
c. uNo; uthe uOIG udoes unot uhave uany uinput uon uthe uIRO uused uunder uany ucircumstance.
d. uNo; uthe uOIG udoes unot uspecify uthe uIRO uto ube uused, ubut udoes uretain uthe uright uto unotify
uthe uprovider uif uthey umust uselect ua unew uIRO. u- ucorrect uanswer.d. uNo; uthe uOIG udoes unot
uspecify uthe uIRO uto ube uused, ubut udoes uretain uthe uright uto unotify uthe uprovider uif uthey umust
uselect ua unew uIRO.
The uOIG uwill unot uendorse uany uparticular uIRO, ubut umost uCIAs uinclude ulanguage uthat
ugives uthe uOIG uthe uopportunity uto unotify ua uprovider uthat uits uchoice uof uIRO uis
uunacceptable uwithin u30 udays uafter uthe uOIG ureceives uwritten unotice uof uthe uidentity uof
uthe uIRO. uIf uthe uOIG uhas uconcerns uregarding uthe uquality uof uthe ureview uor uqualifications
uor uindependence uof uthe uIRO uduring uthe uterm uof uthe uCIA, uit uwill umake uthe uconcerns
uknown uand umay urequest uthat uthe uagreement uwith uthe uIRO ube uterminated uand uanother
uIRO ube uretained.
What urights udoes ua uprovider uhave uif uhe/she udisagrees uwith ua udemand uletter usent uby uthe
uOIG?
a. uThe uprovider ucan uchoose uto uself-disclose uonce ua udemand uletter uhas ubeen ureceived.
b. uThe uprovider ucan usend uin usupporting udocumentation ufor uthe uclaims uto uthe uOIG ufor
ureview uby ucertified umail.
c. uThe uprovider ucan uonly urespond uto uthe udemand uletter uwith upayment.
d. uThe uprovider ucan urequest ua uhearing ubefore uan uALJ uin uthe uHHS. u- ucorrect uanswer.d.
uThe uprovider ucan urequest ua uhearing ubefore uan uALJ uin uthe uHHS.
,If uthe usubject ureceiving ua udemand uletter ufrom uthe uOIG udisagrees, uhe/she ucan urequest ua
uhearing ubefore uan uadministrative ulaw ujudge u(ALJ) uin uHealth uand uHuman uServices
u(HHS).
Which ustatement uis uTRUE uregarding u1995 uand u1997 uE/M uDocumentation uGuidelines?
a. uThe u1995 uE/M uDocumentation uGuidelines uare umore udetailed uusing ubullets uand
ushading uto udetermine ulevels uof uexams.
b. uThe u1995 uE/M uDocumentation uGuidelines uare unever ubeneficial ufor uspecialists.
c. uThe u1997 uE/M uDocumentation uGuidelines uare unever ubeneficial ufor ugeneral
upractitioners.
d. uThe u1997 uE/M uDocumentation uGuidelines uare umore udetailed uusing ubullets uand
ushading uto udetermine ulevels uof uexams. u- ucorrect uanswer.d. uThe u1997 uE/M
uDocumentation uGuidelines uare umore udetailed uusing ubullets uand ushading uto udetermine
ulevels uof uexams.
The u1995 uE/M uDocumentation uGuidelines uare uvague uin uthe udescription uof uthe uexam
uwhereas uthe u1997 uE/M uDocumentation uGuidelines uare umore udetailed uusing ubullets uand
ushading uto udetermine ulevels uof uexams.
A uCorporate uIntegrity uAgreement u(CIA) uhas ucore urequirements. uWhich uoption uis uNOT
uone uof uthe ucore urequirements?
a. uProvide uan uimplementation ureport uand uannual ureports uto uOIG uon uthe ustatus uof uthe
uentity's ucompliance uactivities.
b. uHire uan uOIG uemployee uto uoversee uthe ucompliance uefforts.
c. uDevelop uwritten ustandards uand upolicies.
d. uRestrict uemployment uof uineligible upersons. u- ucorrect uanswer.b. uHire uan uOIG
uemployee uto uoversee uthe ucompliance uefforts
A ucomprehensive uCIA utypically ulasts u5 uyears uand uincludes urequirements uto: u
· uhire ua ucompliance uofficer/appoint ua ucompliance ucommittee; u
· udevelop uwritten ustandards uand upolicies; u
· uimplement ua ucomprehensive uemployee utraining uprogram; u
· uretain uan uindependent ureview uorganization uto uconduct uannual ureviews; u
· uestablish ua uconfidential udisclosure uprogram; u
· urestrict uemployment uof uineligible upersons; u
· ureport uoverpayments, ureportable uevents, uand uongoing uinvestigations/legal
uproceedings; uand u
· uprovide uan uimplementation ureport uand uannual ureports uto uOIG uon uthe ustatus uof uthe
uentity's ucompliance uactivities.
Which uOIG upublication uidentifies uvarious uprojects uthat uare uand uwill ube uaddressed uby uthe
uOffice uof uAudit uServices, uOffice uof uEvaluation uand uInspections, uOffice uof uInvestigations,
uand uOffice uof uCounsel uto uthe uInspector uGeneral?
a. uOIG uWork uPlan
b. uSemiannual uReport uto uCongress
c. uCompendium uof uUnimplemented uRecommendations
d. uOIG uCompliance uPlan uGuidance u- ucorrect uanswer.a. uOIG uWork uPlan
, Rationale: uThe uHHS uOIG upublishes uits uWork uPlan uon uits uwebsite uthat ulists uthe uvarious
uprojects, uwhich uare uor uwill ube uaddressed uby uthe uOffice uof uAudit uServices, uOffice uof
uEvaluation uand uInspections, uOffice uof uInvestigations, uand uOffice uof uCounsel uto uthe
uInspector uGeneral.
When ua uprovider uis uexcluded uunder uthe uExclusions uStatute, uwhat umust uhe uor ushe udo uat
uthe uend uof uthe uexclusionary uperiod?
a. uThe uprovider uis uautomatically ureinstated.
b. uThe uprovider umust uapply ufor ureinstatement.
c. uThe uprovider ucannot ube ureinstated uonce uexcluded.
d. uThe uprovider umust uapply ufor ua ugroup uprovider unumber. u- ucorrect uanswer.b. uThe
uprovider umust uapply ufor ureinstatement.
When uthe uexclusionary uperiod uhas uended, uthe uindividual uor uentity umust uapply ufor
ureinstatement uand ureceive uauthorized unotice ufrom uOIG uthat ureinstatement uhas ubeen
ugranted.
You uaudit ua uprovider uwho uis uconsistently ureporting umultiple uunits uof uCPT ucode u11042.
uWhat ureferences ucan uyou uuse uto ushow uthe uprovider umultiple uunits uof uCPT ucode u11042
uare unot uallowed uand uexplain uhow uit ushould ube ureported?
a. uCPT ucodebook uand uMUE u(Medical uUnlikely uEdits) utable.
b. uCPT ucodebook uand uNCCI uprocedure-to-procedure u(PTP) uedits.
c. uMUE utable uonly.
d. uHCPCS ucodebook uand uNCCI uprocedure-to-procedure u(PTP) uedits. u- ucorrect
uanswer.a. uCPT ucodebook uand uMUE u(Medical uUnlikely uEdits) utable.
What uis uanother uname ufor uthe uFederal uFalse uClaims uAct u(FCA)?
a. uOperation uRestore uTrust
b. uKennedy-Kassebaum uLaw
c. uLincoln uLaw
d. uStark uLaw u- ucorrect uanswer.c. uLincoln uLaw
Also ucalled uthe uLincoln uLaw, uthe uFalse uClaims uAct u(31 uU.S.C. u§§ u3729 u- u3733) uwas
uenacted uin u1863 uto ucombat ufraud uby usuppliers uof ugoods uto uthe uUnion uArmy uduring uthe
uU.S. uCivil uWar.
A uprovider uconsistently ucharges ua uhigher ulevel uof uE/M uservice uthan uis udocumented uto
uhelp ucover uthe ucost uof uhis udeclining upractice. uWould uthis ube ufraud uor uabuse, uand uwhy?
a. uAbuse; ucharging uone ulevel uhigher uon ueach uvisit udoes unot ushow uintent.
b. uAbuse; uthe uprovider's upractice uis ucommon uand utherefore uwould unot ube uconsidered
ufraudulent.
c. uFraud; uany uover-coding uof uservices uwould ube uconsidered ufraudulent.
d. uFraud; uthe uprovider uintentionally uover-coded uto ugain ufinancially. u- ucorrect uanswer.d.
uFraud; uthe uprovider uintentionally uover-coded uto ugain ufinancially.
A uQui uTam uRelator umay ureceive uwhat utype uof uaward ufor ubringing ua ucase uin uwhich uthe
ugovernment uintervenes?
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