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AAPC CASES CPMA REVIEW COMPLETE UPDATE
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?
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?
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:
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?
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
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%
Which of the following code combinations is an example of unbundling?
D. 14000, 11401
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 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?
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
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?
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
C. Modifier 59 is not appropriate when billing 60225 and 64530 regardless of the documentati
