Cpma exam chapter 3 2024 - Study guides, Class notes & Summaries

CPMA- Chapter one exam Questions and Answers In the NCCI edits, what does modifier indicator nine (9) represent? A modifier may be used to bypass the edits if the documentation supports the modifier. B. A modifier is not allowed to bypass the NCCI edits. C. Only modifier 59 can be used to bypass the edit. D. Modifiers are not applicable to the edits, the NCCI edit is not in effect. - Answer-D. Modifiers are not applicable to the edits, the NCCI edit is not in effect. Rationale: The Correc...

CPMA Exam Chapter 3 Study Guide with Verified Solutions Accurate reimbursement begins with - Answer-accurate coding and rules that vary by payer The CPT codebook contains - Answer-instructions, coding guidelines, parenthetical notes, and symbols to provide guidance for proper coding. Not all payers follow CPT coding guidelines. - Answer-An auditor must be able to apply payer variations to the CPT guidelines during an audit, and must communicate the differences in a way that will make sens...

Chapter 5 CPMA Exam: Contract-based Commercial Insurance Plans Questions and Answers Most common commercial insurance plans are - Answer-contract based That is, benefits arise primarily under a contract between the insurance company and the subscriber/patient Where the healthcare provider is in network, - Answer-the provider agrees to abide by certain rules in a separate contract.. The auditor must review the contract to determine the rules the provider is bound to follow For commercial...

CPMA Exam Chapter 5: Self-Disclosure Audits Study Guide The OIG Self-Disclosure Protocol (SDP) provides the - Answer-ability to self-disclose potential instances of fraud involving federal healthcare programs for which liability arises under the OIG's civil money penalty authorities The SDP (Self-Disclosure Protocol) is not for reporting of - Answer-potential or actual Stark (self-referral) violations; It is not a means to obtain an advisory opinion to determine if the suspect conduct ...