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CPMA Top Exam Questions and answers. Approved Rated A+

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CPMA Top Exam Questions and answers. Approved Rated A+ Which option is NOT part of the seven elements that should be included in a compliance plan based on the OIG's recommendations? a. Respondi... ng promptly to detected offenses and developing corrective action. b. Conducting effective training and education. c. Identifying employees on the exclusions list. d. Developing effective lines of communication. - ✔✔-c. Identifying employees on the exclusions list. The OIG's Compliance Program Guidance for Individual and Small Physician Group Practices identifies four risk areas affecting physician practices. What are the four risk areas? - ✔✔-Coding and billing; reasonable and necessary services; documentation; and improper inducements, kickbacks, and selfreferrals. What does the MUE table tell? - ✔✔-maximum number of units a procedure can be reported on the same date of service What does MUE stand for? - ✔✔-Medically Unlikely Edits What does CMS stand for? - ✔✔-Centers for Medicare and Medicaid What does CIA stand for? - ✔✔-Corporate Integrity Agreeement What is a corporate integrity agreement? - ✔✔-Document outlining the obligations that a company involved in health care in the United States makes with a federal government agency or a state government as part of a civil settlement Which is not a core requirement of CIAs? a. Restrict employment of ineligible persons. b. Hire an OIG employee to oversee the compliance efforts. c. Develop written standards and policies. d. Provide 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. What is a Complex audit review? - ✔✔-A complex review is based on data and potential human review of a medical record or other documentation. What is an automated audit review? - ✔✔-Review based solely on the submitted claims and regulatory guidelines. No medical records are needed. What is Qui Tam Relator? - ✔✔-A person who brings a civil action for a violation for him/herself and for the US Government What are the MIPS performance categories? - ✔✔-I. Costs II. Advance Care Info. (Promoting Interoperability) III. Quality IV. Improvement Activities When a Discovery Sample is performed, what error rate requires a Full Sample to be reviewed? - ✔✔-An error rate that exceeds five percent. What program is provided by the OIG to assist in random selection of charts for a Discovery Sample? - ✔✔-The OIG provides a statistical sampling program called RAT-STATS. When a provider is excluded under the Exclusions Statute, what must he or she do at the end of the exclusionary period? - ✔✔-The provider must apply for reinstatement. Which are the requirements for financial penalties to be mitigated in a federal False Claims Act case? - ✔✔--Person self discloses within 30 days of knowing about the violation. -No criminal prosecution, civil action, or administrative action has commenced -The person in violation fully cooperate What can the provider do if they disagree with a demand letter from the OIG initiating CMPs? - ✔✔- Request a hearing before an HHS ALJ. What is a CMP? - ✔✔-Civil Monetary Penalty What is fraud? - ✔✔-knowingly making false statements or misrepresenting facts to obtain an undeserved benefit or payment What is abuse? - ✔✔-an action resulting in unnecessary costs to a federal healthcare program, either directly or indirectly. Examples of Fraud? - ✔✔--Billing for services and/or supplies not provided -Altering claim forms to receive a higher payment -Billing for services at a higher level than provided or necessary -Misrepresenting the diagnosis to justify payment -Making referrals for certain designated services that are prohibited Examples of abuse? - ✔✔--Misusing codes on a claim -Charging excessively for services or supplies -Billing for services that not medically necessary -Failure to maintain adequate medical or financial records -Improper billing practices -Billing Medicare patients a higher fee schedule than non-Medicare patients What regulation is the penalty for violating the False Claims Act (FCA) increased by? - ✔✔-The Federal Civil Penalties Inflation Adjustment Act How much can a provider be penalized through FCA? - ✔✔-The statute originally provided for a civil penalty of not less than $5,000, and not more than $10,000, per claim, plus three times the amount of the government damages if FCA liability was found. This amount is occasionally increased based on the Federal Civil Penalties Inflation Adjustment Act What can a provider do if he or she disagrees with a demand letter se [Show More]

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