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CPMA |! EXAM |! MULTIPLE |! CHOICE |!
WITH |! ACCURATE |! DETAILED |!
ANSWERS
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. 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. c. |! 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. d. |! Continue |! to |! watch |! the |! employee |! in |! non-compliance |! until |! the |! incidents |! meet |! a |! federal |! level |! before |! taking |! action. |! - |! Correct |! answer |! ✔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? a. |! Abuse,charging |! one |! level |! higher |! on |! each |! visits |! does |! not |! show |! intent. b. |! Abuse; |! the |! provider's |! practice |! is |! common |! and |! therefore |! would |! not |! be |! considered |! fraudulent |!. |! c. |! Fraud; |! and |! over-coding |! of |! services |! would |! be |! considered |! fraudulent. d. |! Fraud; |! the |! provider |! intentionally |! over-coded |! to |! gain |! financially. |! - |! Correct |! answer |! ✔d. |! Fraud; |! the |! provider |! intentionally |! over-coded |! to |! gain |! financially. 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? a. |! Unbundling b. |! Under |! Coding c. |! Overuse |! of |! E/M |! codes
civil |! action |! for |! violation |! under |! the |! FCA |! for |! themselves |! and |! the |! government. What |! is |! CoP? a. |! Medicare |! Conditions |! of |! Participation. b. |! TriCare's |! Compliance |! of |! Physicians |! Guidance c. |! Medicaid's |! Coordination |! of |! Physician |! Groups d. |! Commercial |! Programs |! - |! Correct |! answer |! ✔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? a. |! the |! provider |! is |! automatically |! reinstated b. |! The |! provider |! must |! apply |! for |! reinstatement. c. |! The |! provider |! cannot |! be |! reinstated |! once |! excluded. d. |! The |! provider |! must |! apply |! for |! a |! group |! provider |! number. |! - |! Correct |! answer |! ✔b. |! The |! provider |! must |! apply |! for |! reinstatement Which |! option |! is |! considered |! a |! material |! breach |! of |! CIA? |!
a. |! Failure |! to |! engage |! and |! use |! an |! IRO |! in |! accordance |! with |! the |! CIA. b. |! Failure |! to |! hire |! an |! OIG |! employee |! to |! oversee |! compliance |! efforts. c. |! Failure |! to |! hire |! a |! full-time |! internal |! auditor |! to |! review |! every |! claim |! before |! it |! is |! submitted. d. |! Failure |! to |! fire |! auditors |! who |! do |! not |! agree |! with |! the |! provider's |! coding |! - |! Correct |! answer |! ✔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? |! a. |! 1995 |! E/M |! Documentation |! Guidelines b. |! 1997 |! E/M |! Documentation |! Guidelines c. |! The |! practice |! must |! choose |! either |! the |! 1995 |! or |! 1997 |! E/M |! Documentation |! Guidelines |! for |! the |! entire |! practice. d. |! The |! practice |! may |! use |! 1995 |! or |! 1997 |! E/M |! Documentation |! Guidelines |! for |! each |! visit; |! whichever |! is |! most |! advantageous |! for |! that |! visit. |! - |! Correct |! answer |! ✔d. |! The |! practice |! may |! use |! 1995 |! or |! 1997 |! E/M |! Documentation |! Guidelines |! for |! each |! visit; |! whichever |! is |! most |! advantageous |! for |! that |! visit.
d. |! Developing |! effective |! lines |! of |! communication |! - |! Correct |! answer |! ✔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? a. |! Submit |! a |! discussion |! period |! request |! within |! 15 |! days |! of |! the |! date |! of |! the |! demand |! letter. b. |! Submit |! a |! discussion |! period |! request |! within |! 120 |! days |! of |! the |! date |! of |! the |! demand |! letter. c. |! Submit |! a |! request |! for |! review |! to |! the |! MAC |! within |! 15 |! days |! from |! the |! date |! of |! the |! demand |! letter. d. |! Submit |! a |! request |! for |! review |! to |! the |! MAC |! within |! 120 |! days |! from |! the |! date |! of |! the |! demand |! letter. |! - |! Correct |! answer |! ✔a. |! Submit |! a |! discussion |! period |! request |! within |! 15 |! days |! of |! the |! date |! of |! the |! demand |! letter. A. |! Qui |! Tam |! Relator |! may |! receive |! what |! type |! of |! award |! for |! bringing |! a |! case |! on |! which |! the |! government |! intervenes? a. |! 10-15 |! percent |! of |! the |! money |! recovered b. |! 15-25 |! percent |! of |! the |! money |! recovered |!
c. |! 10-15 |! percent |! of |! the |! total |! claim |! amount |! d. |! 15-25 |! percent |! of |! the |! total |! claim |! amount |! - |! Correct |! answer |! ✔b. |! 15-25 |! percent |! of |! the |! money |! recovered A |! corporate |! Integrity |! Agreement |! (CIA |! ) |! has |! seven |! core |! elements. |! Which |! option |! is |! NOT |! one |! of |! the |! core |! elements? a. |! Provider |! an |! implementation |! report |! and |! annual |! reports |! to |! OIG |! on |! the |! status |! of |! the |! entity's |! compliance |! activities. b. |! Hire |! an |! OIG |! employee |! to |! oversee |! the |! compliance |! efforts c. |! Develop |! written |! standards |! and |! policies d. |! Restrict |! employment |! of |! ineligible |! persons. |! - |! Correct |! answer |! ✔b. |! Hire |! an |! OIG |! employee |! to |! oversee |! the |! compliance |! efforts Recovery |! auditors |! may |! perform |! three |! types |! of |! reviews. |! What |! review |! requires |! medical |! records? a. |! Automated |! b. |! Semi |! Automated |!
c. |! The |! Stark |! law |! refers |! to |! fraudulent |! billing; |! the |! Anti-Kickback |! law |! refers |! to |! remuneration |! for |! self |! referrals. d. |! The |! Anti-Kickback |! law |! refers |! to |! fraudulent |! billing; |! the |! Stark |! law |! refers |! to |! remuneration |! for |! self |! referrals. |! - |! Correct |! answer |! ✔a. |! No |! intent |! must |! be |! proven |! for |! the |! Stark |! law; |! the |! Anti-Kickback |! law |! requires |! proof |! of |! intention. What |! is |! another |! name |! for |! the |! Federal |! False |! Claims |! Act? a. |! Operation |! Restore |! Trust b. |! Kennedy-Kassebaum |! Law c. |! Lincoln |! Law d. |! Stark |! Law |! - |! Correct |! answer |! ✔c. |! Lincoln |! Law According |! to |! this |! excerpt |! from |! the |! MUE |! table, |! which |! procedure |! can |! be |! reported |! with |! more |! than |! two |! units |! on |! the |! same |! date |! of |! service? |! HCPCS/CPT |! CODE |! Practitioner |! Services |! MUE |! Values |! 15758 |! 3 15760 |! 2
a. |! 15758 b. |! 15770 c. |! 15776 d. |! 15780 |! - |! Correct |! answer |! ✔a. |! 15758 Recovery |! auditors |! may |! perform |! three |! types |! of |! reviews. |! What |! is |! an |! automated |! review? a. |! Review |! based |! solely |! on |! the |! submitted |! claims |! and |! regulatory |! guidelines. |! No |! medical |! records |! are |! needed. b. |! Review |! based |! on |! data |! and |! potential |! human |! review |! of |! a |! medical |! record |! or |! other |! documentation. c. |! Medical |! records |! are |! required |! for |! review
c. |! The |! provider |! can |! only |! respond |! to |! the |! demand |! letter |! with |! payment. d. |! The |! provider |! can |! request |! a |! hearing |! before |! and |! ALJ |! in |! HHS. |! - |! Correct |! answer |! ✔d. |! The |! provider |! can |! request |! a |! hearing |! before |! and |! ALJ |! in |! HHS. When |! an |! IRO |! is |! completing |! a |! CIA |! Discovery |! Sample, |! how |! many |! sampling |! units |! are |! reviewed? a. |! 10 b. |! 50 c. |! 100 d. |! 200 |! - |! Correct |! answer |! ✔b. |! 50 In |! the |! NCCI |! edits, |! what |! does |! modifier |! indicator |! one |! represent? a. |! A |! modifiers |! is |! not |! allowed |! to |! bypass |! the |! NCCI |! edits |! b. |! A |! modifier |! may |! be |! used |! to |! bypass |! the |! edits |! if |! the |! documentation |! supports |! the |! modifier.
c. |! Modifiers |! are |! not |! applicable |! to |! the |! edits. d. |! The |! NCCI |! edit |! is |! not |! in |! effect. |! - |! Correct |! answer |! ✔b. |! A |! modifier |! may |! be |! used |! to |! bypass |! the |! edits |! if |! the |! documentation |! supports |! the |! modifier. What |! program |! is |! provided |! by |! the |! OIG |! to |! assist |! in |! random |! selection |! of |! charts |! for |! Discovery |! Sample? a. |! The |! OIG |! provides |! an |! on-site |! investigator |! to |! randomly |! select |! the |! charts |! for |! the |! Discovery |! Sample. b. |! The |! OIG |! provides |! a |! statistical |! sampling |! program |! called |! RAT-STATS. c. |! The |! OIG |! recommends |! using |! Excel |! for |! statistical |! sampling. d. |! The |! OIG |! does |! not |! have |! a |! program |! to |! assist |! in |! random |! sampling. |! - |! Correct |! answer |! ✔b. |! The |! OIG |! provides |! a |! statistical |! sampling |! program |! called |! RAT-STATS. The |! FCA |! allows |! for |! reduced |! penalties |! if |! the |! person |! in |! violation |! self-disclose |! s |! if |! which |! conditions |! exist? a. |! The |! person |! furnishes |! all |! information |! about |! the |! violation |! within |! 30 |! days |! after |! which |! the |! defendant |! first |! obtained |! the |! information.
a. |! The |! 1997 |! E/M |! Documentation |! Guidelines |! are |! more |! detailed |! using |! bullets |! and |! shading |! to |! determine |! evels |! of |! exams |!. b. |! The |! 1995 |! E/M |! Documentation |! Guidelines |! are |! never |! beneficial |! for |! specialists. c. |! The |! 1997 |! E/M |! Documentation |! Guidelines |! are |! beneficial |! for |! general |! practitioners. d. |! The |! 1997 |! E/M |! Documentation |! Guidelines |! are |! more |! detailed |! using |! bullets |! and |! shading |! to |! determine |! levels |! of |! exams. |! - |! Correct |! answer |! ✔d. |! The |! 1997 |! E/M |! Documentation |! Guidelines |! are |! more |! detailed |! using |! bullets |! and |! shading |! to |! determine |! levels |! of |! exams. Which |! OIG |! publication |! is |! released |! every |! year |! to |! identify |! various |! projects |! that |! will |! be |! addressed |! during |! the |! fiscal |! year |! by |! the |! Office |! of |! Audit |! Services, |! Office |! of |! Evaluation |! and |! Inspections |! , |! Office |! of |! investigations, |! and |! Office |! of |! Counsel |! to |! the |! Inspector |! General? |! a. |! OIG |! Work |! Plan b. |! Semiannual |! Report |! to |! Congress |! C. |! Compendium |! of |! Unimplemented |! Recommendations d. |! OIG |! Complaince |! Plan |! Guidance |! - |! Correct |! answer |! ✔a. |! OIG |! Work |! Plan
Which |! CCM |! indicator |! allows |! a |! modifier |! to |! be |! appended |! to |! bypass |! an |! NCCI |! edits? |! a. |! 0 b. |! 1 c. |! 9 d. |! None |! - |! Correct |! answer |! ✔d. |! None In |! the |! NCCI |! edits, |! what |! does |! modifier |! indicator |! nine |! represent? a. |! A |! modifier |! is |! not |! allowed |! to |! bypass |! the |! NCCI |! edits |! b. |! A |! modifier |! may |! be |! used |! to |! bypass |! the |! edits |! if |! the |! documentation |! supports |! the |! modifier c. |! Modifiers |! are |! not |! applicable |! he |! edits, |! the |! NCCI |! edit |! is |! not |! in |! effect d. |! Only |! modifier |! 59 |! can |! be |! used |! to |! bypass |! the |! edit. |! - |! Correct |! answer |! ✔c. |! Modifiers |! are |! not |! applicable |! he |! edits, |! the |! NCCI |! edit |! is |! not |! in |! effect
d. |! Billing |! for |! services |! at |! a |! higher |! level |! than |! provided |! or |! necessary. |! - |! Correct |! answer |! ✔d. |! Billing |! for |! services |! at |! a |! higher |! level |! than |! provided |! or |! necessary. What |! is |! the |! maximum |! penalty |! the |! OIG |! may |! seek |! for |! fraudulent |! claims? a. |! 10,000 |! per |! item |! or |! service. b. |! 15,000 |! per |! item |! or |! service. c.10,000 |! per |! item |! or |! service |! plus |! three |! times |! the |! amount |! of |! over-payments. d. |! 15,000 |! per |! item |! or |! service |! plus |! three |! ties |! the |! amount |! of |! over-payments. |! - |! Correct |! answer |! ✔c.10,000 |! per |! item |! or |! service |! plus |! three |! times |! the |! amount |! of |! over-payments. The |! OIG |! Work |! Plan |! is |! divided |! into |! seven |! parts. |! Which |! option |! is |! a |! part |! of |! the |! OIG |! work |! plan |! most |! applicable |! to |! physician? a. |! Medicare |! Part |! A |! and |! Part |! B b. |! Public |! Health |! Reviews |! c. |! Human |! Services |! Reviews |!
d. |! Corporate |! Integrity |! Agreements |! - |! Correct |! answer |! ✔a. |! Medicare |! Part |! A |! and |! Part |! B 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 |! - |! Correct |! answer |! ✔a. |! CPT |! codebook |! and |! MUE |! table The |! OIG |! determines |! a |! provider |! is |! guilty |! of |! submitting |! 10 |! fraudulent |! claims |! resulting |! in |! $25,000 |! in |! over |! payments |! made |! to |! the |! provider. |! What |! is |! the |! maximum |! penalty |! the |! OIG |! may |! seek? a.$ |! 75, b. |! $100, c. |! $125,
