AAPC CASES CPMA Exam Review With 100% Correct Answers 2023-2024, Exams of Advanced Education

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AAPC CASES CPMA Exam Review With

100% Correct Answers 2023-

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 reason for the denial? - Correct Answer-The payer contract may bundle the E/M service when performed on the same day as the minor surgery Which type of case is not prosecuted under the federal false claims act? - Correct Answer-A. Physician tax issues What are the recommended number of charts to audit per provider and the minimum frequency of the audit? - Correct Answer-C. 10 records per provider each year How is RAT-STATS used by an auditor? - Correct Answer-B. Software used in performing statistical random samples and evaluating results A comprehensive audit is: - Correct Answer-A. A large number of claims are selected for a review that might be focused on specific procedure and/or diagnosis codes. According to the 2017 _________, the OIG will review Medicare Part B payments for prolonged services to determine whether the payments were made according to Medicare requirements. - Correct Answer-B. OIG Work Plan Commercial and Government carriers audit medical records. Select the statement that is true regarding commercial and government carriers. - Correct Answer-B. Commercial carriers and Government carriers both use claims data to find locate providers and services to audit. 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 Dr. Martin: Date of Service 06/01/20xx Procedure 35556-76 What procedure should Dr. Martin report? - Correct Answer-D. 35558- What is the minimum signature requirements of the author of an entry in the medical record? - Correct Answer-B. 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-C. Personal biographical data and consent for treatment or authorization for treatment form 60225 Column 1 64530 Column 2

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Modifier 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.