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CPMA |! Newest |! 2025 |! / |! 2026 |! Exam |!
with |! complete |! solutions
What |! is |! the |! minimum |! signature |! assignment(s) |! of |! the |! author |! of |! an |! entry |! in |! the |! medical |! record? |! - |! Correct |! answer |! ✔The |! first |! initial, |! last |! name |! and |! credentials Based |! on |! Joint |! Commission |! accreditation |! guidance |! for |! personal |! data, |! what |! two |! elements |! must |! be |! evident |! in |! the |! medical |! record |! - |! Correct |! answer |! ✔Personal |! biographical |! data |! and |! consent |! for |! treatment |! or |! authorization |! for |! treatment |! form As |! an |! auditor, |! who |! of |! the |! following |! would |! NOT |! be |! expected |! to |! submit |! operative |! notes? |! - |! Correct |! answer |! ✔Surgical |! assistants What |! is |! the |! appropriate |! way |! to |! dispose |! of |! PHI |! that |! is |! no |! longer |! needed? |! - |! Correct |! answer |! ✔Discard |! it |! in |! a |! locked |! shredding |! receptacle 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 |! decision Patients |! can |! request |! copies |! of |! disclosure |! of |! PHI |! under |! HIPAA |! - |! Correct |! answer |! ✔For |! a |! six |! (6) |! year |! period |! of |! time
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 For |! the |! civil |! monetary |! penalties, |! for |! false |! or |! fraudulent |! claims, |! up |! to |! how |! many |! times |! of |! the |! amount |! damages |! are |! for |! each |! false |! claim |! submitted? |! - |! Correct |! answer |! ✔Three |! times |! the |! amount |! improperly |! claimed Which |! type |! of |! case |! is |! not |! prosecuted |! under |! the |! federal |! false |! claims |! act? |! - |! Correct |! answer |! ✔Physician |! Tax |! Issues 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 |! ✔5% The |! Stark |! Statute |! applies |! to... |! - |! Correct |! answer |! ✔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 When |! can |! a |! RAC |! extrapolate |! the |! overpayment(s) |! on |! claims? |! - |! Correct |! answer |! ✔If |! a |! RAC |! can |! demonstrate |! a |! high |! level |! of |! error, |! the |! RAC |! can |! then |! extrapolate |! the |! findings |! and |! request |! a |! refund.
Current |! amount |! of |! civil |! monetary |! penalties |! - |! Correct |! answer |! ✔Range |! from |! $10,000-$50,000 |! per |! violation |! and |! an |! assessment |! of |! up |! to |! 3 |! times |! the |! amount |! of |! the |! over-payments How |! many |! sampling |! units |! are |! selected |! for |! review |! in |! a |! Discovery |! Sample |! under |! a |! Corporate |! Integrity |! Agreement? |! - |! Correct |! answer |! ✔ 50 Required |! by |! the |! OIG |! s |! a |! condition |! of |! not |! seeking |! exclusion |! from |! participation |! when |! an |! individual |! or |! entity |! seeks |! to |! settle |! civil |! healthcare |! fraud |! cases; |! typically |! last |! 5 |! yrs |! but |! can |! be |! longer; |! most |! have |! the |! same |! core |! requirements |! along |! with |! specific |! steps |! for |! the |! individual |! or |! entity |! that |! are |! related |! to |! the |! conduct |! that |! led |! to |! the |! settlement |! - |! Correct |! answer |! ✔Corporate |! Integrity |! Agreements What |! is |! a |! Correct |! Coding |! Indicator |! of |! 0? |! - |! Correct |! answer |! ✔A |! modifier |! is |! not |! allowed |! and |! will |! not |! bypass |! edits What |! is |! a |! Correct |! Coding |! Indicator |! of |! 1? |! - |! Correct |! answer |! ✔A |! modifier |! is |! allowed |! and |! will |! bypass |! edits What |! is |! a |! Correct |! Coding |! Indicator |! of |! 9? |! - |! Correct |! answer |! ✔The |! use |! of |! a |! modifier |! is |! not |! specified The |! Goal |! of |! the |! Recovery |! Audit |! Contractor |! program |! is |! to |! - |! Correct |! answer |! ✔Identify |! improper |! payments |! made |! on |! claims |! of |! healthcare |! services |! provided |! to |! Medicare |! beneficiaries
What |! is |! an |! Automated |! Review? |! - |! Correct |! answer |! ✔No |! Medical |! Records |! Needed |! to |! make |! claims |! determinations What |! is |! a |! Complex |! Review? |! - |! Correct |! answer |! ✔Requires |! Medical |! Records |! review |! to |! make |! claims |! determination What |! is |! considered |! Medicare |! Abuse? |! - |! Correct |! answer |! ✔Misusing |! codes |! on |! a |! claim What |! is |! the |! most |! significant |! difference |! between |! the |! 1995 |! and |! 1997 |! Documentation |! Guidelines? |! - |! Correct |! answer |! ✔examination Submitting |! Claims |! for |! expired |! drugs |! falls |! under |! the? |! - |! Correct |! answer |! ✔False |! Claims |! Act The |! False |! Claim |! Act |! allows |! for |! mitigation |! under |! what |! circumstances? |! - |! Correct |! answer |! ✔The |! person |! committing |! the |! violation |! self-discloses |! and |! provides |! all |! known |! information |! within |! 30 |! days, |! fully |! cooperates |! with |! investigation, |! and |! there |! is |! no |! criminal |! prosecution, |! civil |! action, |! or |! administrative |! action |! regarding |! the |! violation. What |! document |! identifies |! the |! areas |! that |! will |! be |! scrutinized |! by |! the |! federal |! government |! in |! the |! current |! and |! upcoming |! year? |! - |! Correct |! answer |! ✔OIG |! Work |! Plan
The |! Procedure |! Performed Primary |! Surgeon Assistant |! Surgeon Anesthesia |! Administered Anesthesiologist CHEDDAR |! Documentation |! - |! Correct |! answer |! ✔C-Chief |! Complaint H-History |! of |! Present |! Illness E-Exam D-Details D-Drugs |! and |! Dosages A-Assessment R-Return |! Visit |! Information |! or |! referral If |! a |! covered |! entity |! identifies |! material |! breach |! of |! a |! contractual |! agreement |! with |! a |! business |! associate |! and |! the |! contract |! is |! terminated, |! which |! agency |! is |! the |! problem |! reported |! to? |! - |! Correct |! answer |! ✔Office |! for |! Civil |! Rights |! (OCR) What |! is |! an |! example |! under |! the |! Privacy |! Rule |! that |! requires |! a |! written |! agreement |! to |! disclose |! protected |! health |! information? |! - |! Correct |! answer |! ✔A |! physician |! sending |! a |! patient's |! treatment |! plan |! to |! a |! marketing |! pharmaceutical |! company.
What |! identifies |! proper |! protocol |! for |! making |! a |! correction |! to |! a |! paper |! medical |! record? |! - |! Correct |! answer |! ✔A |! single |! line |! strike |! through |! the |! original |! statement, |! signing |! and |! dating |! the |! revision A |! provider |! who |! accepts |! the |! Medicare |! Managed |! Care |! Program |! must |! maintain |! patient |! records |! for |! - |! Correct |! answer |! ✔ 10 |! years What |! is |! the |! major |! risk |! of |! electronic |! health |! records |! as |! an |! auditor? |! - |! Correct |! answer |! ✔Copying |! or |! cloning What |! form |! is |! signed |! by |! the |! patient |! to |! verify |! that |! the |! patient |! understands |! the |! procedures, |! outcomes |! and |! options |! of |! the |! treatment? |! - |! Correct |! answer |! ✔Informed |! Consent What |! is |! the |! CERT |! program? |! - |! Correct |! answer |! ✔The |! Comprehensive |! Error |! Rate |! Testing |! program |! identifies |! errors |! causing |! improper |! payments |! by |! the |! Medicare |! Program. |! The |! errors |! found |! can |! identify |! areas |! for |! providers |! to |! improve |! documentation. Authentication |! of |! a |! report |! by |! a |! physician |! or |! another |! practitioner |! must |! take |! place |! - |! Correct |! answer |! ✔after |! the |! document |! has |! been |! transcribed |! and |! reviewed. If |! a |! provider |! or |! supplier |! has |! been |! approved |! by |! a |! national |! accreditation |! organization |! they |! may |! be |! exempt |! from: |! - |! Correct |! answer |! ✔Routine |! state |! survey |! agencies |! to |! determine |! compliance |! with |! Medicare |! Conditions
A |! qualified |! individual |! who |! is |! medically |! directing |! two |! to |! four |! concurrent |! procedures |! - |! Correct |! answer |! ✔QK An |! anesthesiologist |! that |! medically |! directed |! a |! CRNA |! in |! a |! single |! case |! - |! Correct |! answer |! ✔QY A |! medically |! directed |! CRNA |! - |! Correct |! answer |! ✔QX CRNA |! who |! is |! performing |! anesthesia |! services |! without |! medical |! direction |! by |! a |! physician |! - |! Correct |! answer |! ✔QZ What |! is |! the |! purpose |! of |! a |! discovery |! sample? |! - |! Correct |! answer |! ✔Used |! to |! determine |! the |! net |! financial |! error |! rate; |! if |! the |! error |! rate |! exceeds |! 5%, |! a |! Full |! Sample |! must |! be |! reviewed, |! along |! with |! a |! Systems |! Review What |! is |! the |! name |! of |! the |! statistical |! sampling |! program |! provided |! by |! the |! OIG |! to |! randomly |! select |! and |! determine |! the |! size |! of |! the |! Discovery |! Sample? |! - |! Correct |! answer |! ✔RAT-STATS What |! percent |! of |! precision |! and |! confidence |! are |! required |! to |! estimate |! the |! overpayment? |! - |! Correct |! answer |! ✔90% |! confidence |! and |! 25% |! precision |! level Are |! compliance |! plans |! mandatory? |! - |! Correct |! answer |! ✔No |! they |! are |! currently |! voluntary, |! however |! the |! ACA |! makes |! compliance |! programs |! mandatory |! for |! providers |! and |! other |! healthcare |! providers
How |! many |! elements |! has |! the |! OIG |! identified |! that |! should |! be |! present |! in |! every |! compliance |! plan? |! - |! Correct |! answer |! ✔ 7 What |! should |! be |! included |! in |! the |! documentation |! of |! a |! finding |! of |! non- compliant |! conduct? |! - |! Correct |! answer |! ✔Date |! of |! incident, |! name |! of |! reporting |! party, |! name |! of |! the |! person |! responsible |! for |! taking |! action, |! and |! the |! follow-up |! action |! taken Can |! a |! provider |! choose |! from |! either |! 1995 |! or |! 1997 |! guidelines |! for |! each |! E/M |! service? |! - |! Correct |! answer |! ✔yes Why |! is |! it |! important |! for |! an |! auditor |! to |! be |! familiar |! with |! both |! sets |! of |! guidelines? |! - |! Correct |! answer |! ✔A |! provider |! can |! choose |! either |! the |! 1995 |! or |! the |! 1997 |! guidelines |! and |! the |! auditor |! must |! determine |! which |! will |! be |! more |! advantageous |! to |! the |! provider Medically |! Unlikely |! Edits |! - |! Correct |! answer |! ✔Define |! the |! maximum |! units |! of |! service |! that |! a |! provider |! would |! report, |! under |! most |! circumstances, |! for |! a |! single |! beneficiary, |! on |! a |! single |! date |! of |! service, |! for |! a |! specific |! code How |! many |! Recovery |! Audit |! Contractors |! does |! Medicare |! currently |! have? |! - |! Correct |! answer |! ✔4, |! divided |! by |! region Fee-For-Service |! (FFS) |! Recovery |! Auditors |! - |! Correct |! answer |! ✔Contract |! with |! CMS |! to |! identify |! Medicare |! FFS |! improper |! payments; |! if |! an |! improper |! payment |! is |! identified, |! a |! review |! results |! letter |! is |! sent |! to |! the |! provider |! that |! includes |! the |! decision |! and |! rationale |! for |! that |! decision
immunizations, |! physical |! examination, |! lab |! report, |! clinical |! impression, |! and |! physician |! orders. 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 |! H |! in |! CHEDDAR Patients |! can |! request |! copies |! of |! disclosure |! of |! PHI |! under |! HIPAA: |! - |! Correct |! answer |! ✔For |! a |! six |! (6) |! year |! period |! of |! time 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 |! that |! 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. A |! provider |! knows |! that |! an |! evaluation |! and |! management |! service |! they |! provide |! on |! the |! same |! date |! as |! a |! major |! procedure |! will |! be |! bundled, |! so |! submits |! the |! claim |! for |! the |! E/M |! with |! a |! different |! date |! of |! service. |! This |! is |! an |! example |! of: |! - |! Correct |! answer |! ✔Fraud
