CPMA Exam Questions And Answers 100 Correct

CPMA Exam Questions And Answers (100% Correct) 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.

• 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.

• 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.

• Continue to watch the employee in non-compliance until the incidents

meet a federal level before taking action. Correct Ans - 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?

• Abuse,charging one level higher on each visits does not show intent.
• Abuse; the provider's practice is common and therefore would not be

considered fraudulent .

• Fraud; and over-coding of services would be considered fraudulent.
• Fraud; the provider intentionally over-coded to gain financially.

Correct Ans - d. Fraud; the provider intentionally over-coded to gain financially. 1 / 4

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?

• Unbundling
• Under Coding
• Overuse of E/M codes
• Failure to follow the "same day" rule Correct Ans - a. Unbundling

The FCA allows for reduced penalties if the person in violation self- discloses if which conditions exist?

• The person furnishes all information about the violation with in 30 days

after which the defendant first obtained the information.

• The person fully cooperates with the investigation.
• There is no additional criminal prosecution, civil action, or administrated

action with the respect to the violation.

• All of the above Correct Ans - d. All of the above

What is a Qui Tam Relator?

• a person who is prosecuted under FCA.
• The defendant in a Stark Law case.
• a person listed on the OIG exclusions list.
• a person who brings civil action for violation under the FCA for

themselves and the government. Correct Ans - d. a person who brings civil action for violation under the FCA for themselves and the government.What is CoP? 2 / 4

• Medicare Conditions of Participation.
• TriCare's Compliance of Physicians Guidance
• Medicaid's Coordination of Physician Groups
• Commercial Programs Correct Ans - a. Medicare Conditions of

Participation.When a provider is excluded under the Exclusions statute, What must he or she do at the end of the exclusionary period?

• the provider is automatically reinstated
• The provider must apply for reinstatement.
• The provider cannot be reinstated once excluded.
• The provider must apply for a group provider number. Correct Ans -
• The provider must apply for reinstatement

Which option is considered a material breach of CIA?

• Failure to engage and use an IRO in accordance with the CIA.
• Failure to hire an OIG employee to oversee compliance efforts.
• Failure to hire a full-time internal auditor to review every claim before it

is submitted.

• Failure to fire auditors who do not agree with the provider's coding

Correct Ans - 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?

• 1995 E/M Documentation Guidelines
• 1997 E/M Documentation Guidelines 3 / 4

• The practice must choose either the 1995 or 1997 E/M Documentation

Guidelines for the entire practice.

• The practice may use 1995 or 1997 E/M Documentation Guidelines for

each visit; whichever is most advantageous for that visit. Correct Ans -

• 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 review based on electronic data examined form submitted claims .
• A review based on electronic data examined from submitted claims but

electively supported by medical records sent by the provider.

• a review based on complete medical records review due lack of Medical

Policy being in a place

• a review based on tips sent in from internal informants. Correct Ans
• 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?

• Conducting effective training and education.
• Responding promptly to detected offenses and developing corrective

action.

• Identifying employees on the exclusions list .
• Developing effective lines of communication Correct Ans - 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?

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