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AAPC CASES CPMA Review questions with precise detailed solutions, Exams of Auditing

AAPC CASES CPMA Review questions with precise detailed solutions

Typology: Exams

2024/2025

Available from 07/05/2025

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AAPC |! CASES |! CPMA |! Review |!
questions |! with |! precise |! detailed |!
solutions
You |! are |! performing |! an |! audit |! of |! evaluation |! and |! management |! services |! for |! a |!
family |! practice |! office. |! In |! the |! encounter, |! you |! read |! the |! physician |! ordered |! and
|! reviewed |! a |! differential |! WBC. |! Which |! of |! the |! following |! best |! describes |! what |!
you |! would |! expect |! to |! see |! in |! the |! medical |! record? |! - |! Correct |! answer |! Patient |!
identification, |! assignment |! of |! benefits, |! patient's |! medical |! history, |!
immunizations, |! physical |! examination, |! lab |! report, |! clinical |! impression, |! and |!
physician |! orders.
As |! an |! auditor, |! who |! of |! the |! following |! would |! NOT |! be |! expected |! to |! submit |!
operative |! notes? |! - |! Correct |! answer |! Surgical |! assistants
A |! provider |! knows |! that |! an |! evaluation |! and |! management |! service |! they |! provide
|! on |! the |! same |! date |! as |! a |! major |! procedure |! will |! be |! bundled, |! so |! he |! submits |! the |!
claim |! for |! the |! E/M |! with |! a |! different |! date |! of |! service. |! This |! is |! an |! example |! of: |! - |!
Correct |! answer |! Fraud
In |! preparation |! for |! a |! high |! volume |! of |! patients |! coming |! in |! for |! chemotherapy, |!
the |! nurse |! documents |! the |! chemotherapy |! treatments |! in |! advance. |! The |!
purpose |! is |! to |! speed |! up |! the |! treatment |! process |! so |! patients |! do |! not |! have |! to |!
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AAPC |! CASES |! CPMA |! Review |!

questions |! with |! precise |! detailed |!

solutions

You |! are |! performing |! an |! audit |! of |! evaluation |! and |! management |! services |! for |! a |! family |! practice |! office. |! In |! the |! encounter, |! you |! read |! the |! physician |! ordered |! and |! reviewed |! a |! differential |! WBC. |! Which |! of |! the |! following |! best |! describes |! what |! you |! would |! expect |! to |! see |! in |! the |! medical |! record? |! - |! Correct |! answer |! ✔Patient |! identification, |! assignment |! of |! benefits, |! patient's |! medical |! history, |! immunizations, |! physical |! examination, |! lab |! report, |! clinical |! impression, |! and |! physician |! orders. As |! an |! auditor, |! who |! of |! the |! following |! would |! NOT |! be |! expected |! to |! submit |! operative |! notes? |! - |! Correct |! answer |! ✔Surgical |! assistants A |! provider |! knows |! that |! an |! evaluation |! and |! management |! service |! they |! provide |! on |! the |! same |! date |! as |! a |! major |! procedure |! will |! be |! bundled, |! so |! he |! submits |! the |! claim |! for |! the |! E/M |! with |! a |! different |! date |! of |! service. |! This |! is |! an |! example |! of: |! - |! Correct |! answer |! ✔Fraud In |! preparation |! for |! a |! high |! volume |! of |! patients |! coming |! in |! for |! chemotherapy, |! the |! nurse |! documents |! the |! chemotherapy |! treatments |! in |! advance. |! The |! purpose |! is |! to |! speed |! up |! the |! treatment |! process |! so |! patients |! do |! not |! have |! to |!

wait |! long. |! Would |! this |! cause |! concern |! in |! an |! audit? |! - |! Correct |! answer |! ✔Yes, |! chart |! entry |! should |! not |! be |! made |! in |! advance |! of |! the |! treatment. Patients |! can |! request |! copies |! of |! disclosure |! of |! PHI |! under |! HIPAA: |! - |! Correct |! answer |! ✔For |! a |! six |! (6) |! year |! period |! of |! time SOAP |! and |! CHEDDAR |! are |! two |! formats |! of |! medical |! record |! documentation. |! Which |! section |! of |! each |! format |! would |! you |! find |! the |! patient's |! history? |! - |! Correct |! answer |! ✔S |! in |! SOAP |! and |! C |! in |! CHEDDAR When |! must |! ABNs |! be |! signed? |! - |! Correct |! answer |! ✔Far |! enough |! in |! advance |! that |! the |! beneficiary |! or |! representative |! has |! time |! to |! consider |! the |! options |! and |! make |! an |! informed |! choice What |! is |! the |! appropriate |! way |! to |! dispose |! of |! PHI |! that |! is |! no |! longer |! needed? |! - |! Correct |! answer |! ✔Discard |! it |! in |! a |! locked |! shredding |! receptacle Which |! of |! the |! following |! would |! NOT |! be |! expected |! to |! fall |! under |! the |! responsibility |! or |! oversight |! of |! an |! organization's |! compliance |! committee? |! - |! Correct |! answer |! ✔C. |! Recommending |! a |! specific |! merit |! increase |! in |! pay |! for |! employee's |! adherence |! to |! the |! code |! of |! conduct A |! family |! physician |! requests |! a |! post |! payment |! audit |! on |! claims |! from |! a |! particular |! commercial |! payer |! from |! which |! he |! is |! receiving |! denials. |! Whenever |! the |! provider |! performs |! a |! minor |! procedure |! with |! an |! E/M |! service, |! the |! minor |! surgery |! is |! reimbursed |! but |! the |! E/M |! service |! is |! denied. |! You |! review |! 10 |! charts |! and |! all |! cases |! are |! documented |! and |! coded |! correctly. |! What |! could |! be |! the |!

A |! full |! sample |! must |! be |! reviewed |! and |! a |! systems |! review |! must |! be |! conducted |! when |! the |! net |! financial |! error |! rate |! of |! the |! sampling |! equals |! or |! exceeds |! what |! percent? |! - |! Correct |! answer |! ✔A. |! 5% Which |! of |! the |! following |! code |! combinations |! is |! an |! example |! of |! unbundling? |! - |! Correct |! answer |! ✔D. |! 14000, |! 11401 Using |! the |! NCCI |! information |! provided, |! which |! of |! the |! following |! statements |! is |! TRUE? |! - |! Correct |! answer |! ✔C. |! Modifier |! 59 |! is |! not |! appropriate |! when |! billing |! 60225 |! and |! 64530 |! regardless |! of |! the |! documentation |! provided. The |! Stark |! Statute |! applies |! to: |! - |! Correct |! answer |! ✔C. |! Only |! physicians |! who |! refer |! Medicare |! and |! Medicaid |! patients |! to |! entities |! for |! designated |! health |! care |! services |! with |! which |! the |! provider |! or |! immediate |! family |! member |! has |! a |! financial |! relationship Which |! of |! the |! following |! scenarios |! qualifies |! for |! the |! use |! of |! modifier |! 25? |! - |! Correct |! answer |! ✔Patient |! presents |! for |! a |! scheduled |! lesion |! removal |! from |! her |! right |! upper |! arm. |! She |! informs |! her |! dermatologist |! that |! she |! is |! starting |! to |! notice |! dry |! patchy |! areas |! on |! her |! arms |! that |! were |! not |! there |! before. |! She |! states |! that |! the |! patches |! are |! itchy |! and |! sometimes |! burn. |! Based |! on |! the |! patient's |! symptoms |! and |! findings |! upon |! exam, |! the |! provider |! diagnoses |! the |! patient |! with |! psoriasis |! and |! prescribes |! a |! topical |! corticosteroid. |! The |! physician |! performs |! the |! scheduled |! lesion |! removal |! and |! sends |! the |! specimen |! to |! pathology. |! The |! patient |! will |! return |! in |! two |! weeks |! to |! discuss |! the |! results. Which |! of |! the |! following |! illustrates |! an |! appropriate |! use |! of |! modifier |! 24? |! - |! Correct |! answer |! ✔A |! physician |! admits |! a |! patient |! to |! a |! skilled |! nursing |! facility |!

during |! a |! global |! period |! for |! a |! condition |! that |! is |! unrelated |! to |! that |! for |! which |! the |! patient |! required |! surgery. |! The |! --Modifier |! 24 |! modifier |! is |! appended |! to |! the |! SNF |! E/M |! service |! code. An |! infectious |! disease |! provider |! has |! been |! notified |! by |! the |! MAC |! (Medicare |! Administrative |! Contractor) |! in |! his |! region |! that |! the |! data |! indicates |! he |! is |! billing |! level |! 99214 |! more |! frequent |! than |! other |! providers |! in |! the |! same |! specialty |! and |! geographic |! region. |! The |! provider |! requests |! you |! audit |! a |! sample |! of |! his |! claims |! that |! were |! coded |! as |! 99214 |! to |! determine |! if |! he |! is |! coding |! appropriately. |! What |! supporting |! references |! will |! you |! need |! to |! conduct |! the |! audit? |! - |! Correct |! answer |! ✔C. |! 1995 |! and |! 1997 |! CMS |! Documentation |! Guidelines When |! can |! a |! RAC |! extrapolate |! the |! overpayment(s) |! on |! claims? |! - |! Correct |! answer |! ✔C. |! If |! a |! RAC |! can |! demonstrate |! a |! high |! level |! of |! error, |! the |! RAC |! can |! then |! extrapolate |! the |! findings |! and |! request |! a |! refund. Example: |! Column |! 1 |! Code/Column |! 2 |! Code |! 45385/45380 |! CPT |! Code |! 45385 |! - |! Colonoscopy, |! flexible, |! proximal |! to |! splenic |! flexure; |! with |! removal |! of |! tumor(s), |! polyp(s), |! or |! other |! lesion(s) |! by |! snare |! technique |! CPT |! Code |! 45380 |! - |! Colonoscopy, |! flexible, |! proximal |! to |! splenic |! flexure; |! with |! biopsy, |! single |! or |! multiple |! Policy: |! More |! extensive |! procedure |! Modifier |! -59 |! is: |! - |! Correct |! answer |! ✔B. |! Only |! appropriate |! if |! the |! two |! procedures |! are |! performed |! on |! separate |! lesions |! or |! at |! separate |! patient |! encounters. Dr. |! Jones |! performed |! a |! femoral-femoral |! bypass |! graft |! in |! the |! morning |! on |! June |! 1, |! 20xx. |! Later |! that |! day, |! the |! graft |! clotted |! and |! the |! entire |! procedure |! was |! repeated. |! Dr. |! Jones |! was |! not |! available |! so |! Dr. |! Martin, |! who |! is |! with |! a |! different |! group, |! repeated |! the |! procedure |! in |! the |! evening. |! The |! auditor |! reviewed |! the |! documentation |! for |! Dr. |! Martin. |! The |! following |! was |! reported |! by |!

0=not |! allowed 1=allowed 9=not |! applicable |! - |! Correct |! answer |! ✔C. |! Modifier |! 59 |! is |! not |! appropriate |! when |! billing |! 60225 |! and |! 64530 |! regardless |! of |! the |! documentation |! provided.