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AAPC CASES CPMA REVIEW COMPLETE UPDATE
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?
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?
A. Physician tax issues
What are the recommended number of charts to audit per provider and the minimum frequency of the audit?
C. 10 records per provider each year
How is RAT-STATS used by an auditor?
B. Software used in performing statistical random samples and evaluating results
A comprehensive audit is:
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.
B. OIG Work Plan
Commercial and Government carriers audit medical records. Select the statement that is true regarding commercial and government carriers.
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?
A. 5%
treatment process so patients do not have to wait long. Would this cause concern in an audit?
Yes, chart entry should not be made in advance of the treatment.
Patients can request copies of disclosure of PHI under HIPAA:
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?
S in SOAP and C in CHEDDAR
When must ABNs be signed?
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?
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?
C. Recommending a specific merit increase in pay for employee's adherence to the code of conduct
Using the NCCI information provided, which of the following statements is TRUE?
C. Modifier 59 is not appropriate when billing 60225 and 64530 regardless of the documentation provided.
The Stark Statute applies to:
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?
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
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:
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- What procedure should Dr. Martin report?
D. 35558-
What is the minimum signature requirements of the author of an entry in the medical record?
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:
C. Personal biographical data and consent for treatment or authorization for treatment form
60225 Column 1
64530 Column 2
Modifier
0=not allowed
1=allowed
9=not applicable
