Download AAPC CPMA Certification Exam Prep: Questions and Answers and more Exams Nursing in PDF only on Docsity!
questions and answers
Regarding time, what MUST the physical therapy provider include on the PT log? - correct answer ✅Time IN and Time OUT. What information should be reported to the OIG in the claims review findings as part of an entity's Annual Report? - correct answer ✅Claims review methodology, statistical sampling documentation, and claim review findings. An analysis that provides an organization an overview of the deficit areas captured by a medical record audit is called what? - correct answer ✅An aggregate analysis. Under what circumstances may providers use or disclose PHI w/o patient consent?
- correct answer ✅Payment, treatment, and operations. What program was established by HIPAA to combat fraud & abuse committed against all health plans both public & private? - correct answer ✅Healthcare Fraud & Abuse Control Program What is the minimum signature requirement of the author entry in a medical record? - correct answer ✅The first initial, the last name, and credentials. As an auditor, who of the following would NOT be expected to submit operative notes? - correct answer ✅A surgical assistant. A patient can request copies of disclosure of PHI under HIPAA: - correct answer ✅For a 6-year period.
questions and answers
Can entries for medical records ever be made in advance? - correct answer ✅NO. The medical record should NEVER be prepared in advance. Based on Joint Commission accreditation guidance for personal data, what 2 elements must be evident in the medical record? - correct answer ✅Personal biographical data and consent for treatment or authorization for treatment form. A full sample must be reviewed, and a systems review must be conducted when he net financial error rate of the sampling equals or exceeds what percent? - correct answer ✅5% 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 & request a refund. For civil monetary penalties for false or fraudulent claims, up to how many times of the amount are damages for each false claim submitted? - correct answer ✅Up to three (3) times the amount improperly claimed. The Stark Statue applies to: - correct answer ✅Only physicians who refer Medicare & Medicaid patients to entities for designated health care services with which the provider or immediate family member has a financial relationship. Codes 45385 and 45380 - Modifier -59 - correct answer ✅Modifier 59 is only appropriate if the 2 procedures are performed on separate lesions or at separate patient encounters.
questions and answers
What section of the operative report typically contains the date of surgery, preoperative diagnosis, postoperative diagnosis, and operation performed? - correct answer ✅The HEADER. Why is it important to read the body of an operative report? - correct answer ✅To identify if the details in the documentation support the surgery listed in the header, if additional procedures have been performed, or if modifiers should be used. What should be documented in Physical Therapy modalities? - correct answer ✅Each individual modality used w/ total duration in mins. What is identified in the indications portion of an operative note? - correct answer ✅A brief history outlining the medical necessity for the procedure. When is incidental use and disclosure of PHI permitted? - correct answer ✅When the covered entity has reasonable safeguards in place to ensure the information shared is being limited to the minimum necessary. How long is a Corporate Integrity Agreement (CIA) usually in force? - correct answer ✅Five (5) years. Which may require an auditor to identify non-standard coding & reimbursement rules? - correct answer ✅Auto & Worker's Comp
questions and answers
Which is a TRUE statement regarding speaking with providers post-audit? - correct answer ✅Focus on what the provider(s) did well, while outlining the areas where they need to do better to achieve compliance & minimize risk. Which section of an audit report would you report consistent findings that attribute to a specific procedure code or particular provider? - correct answer ✅Issue-Oriented Findings What provides an entity the ability to self-disclose the potential instances of fraud involving federal healthcare programs for which liability arises under the Civil Monetary Penalty Law? - correct answer ✅OIG self disclosure protocol (SDP) For Medicare, which administrative agency is responsible for interpretation of the statutory requirements? - correct answer ✅Health and Human Services Who regulates Tri-Care? - correct answer ✅The Department of Defense Under the reverse false claims provision under the FCA, what must be understood by an auditor? - correct answer ✅Declaring an audit error w/o binding standards can inappropriately expose the audited provider to FCA liability. What is an auditor's role in the OIG Self-Disclosure Protocol? (SDP) - correct answer ✅Identifying the scope of the error and auditing the documentation. What type of insurance carrier might be considered a state-regulated commercial insurance plan? - correct answer ✅Worker's Comp
questions and answers
A Qui Tam Relator may receive what type of award for bringing a case in which the government intervenes? - correct answer ✅15-25 percent of the money recovered What action would be considered fraud rather than abuse? - correct answer ✅A provider requiring the coding staff to intentionally code E/M services one level higher than documented. When a discovery sample is performed, what error rate requires a Full Sample to be reviewed? - correct answer ✅An error rate that exceeds 5%. The OIG Compliance Guidance for Individual & Small Group Physician lists UNBUNDLING as a potential risk area among others. - correct answer ✅ What regulation is the penalty for violating the FCA increased by? - correct answer ✅The Federal Civil Penalties Inflation Adjustment Act. What can a provider do if he disagrees with a demand letter sent as a result of a Recovery Audit? - correct answer ✅Submit a discussion period request within 30 days of the demand letter. What must be included in a business associate agreement? - correct answer ✅The permitted and required uses of PHI by the business associate. Under what circumstances may providers use or disclose PHI without patient consent? - correct answer ✅Payment, treatment, or operations.
questions and answers
When a minor procedure is performed in the office, what are the documentation requirements? - correct answer ✅The detail of the procedure can be included in the documentation for the office requirement. What is the HealthCare Fraud & Abuse Control Program? - correct answer ✅A program established by HIPAA to combat fraud and abuse in healthcare. Consultation: - correct answer ✅When a patient initiates a consultation, the consult code is NOT reported. How is wound closure with tissue glue be reported? - correct answer ✅With a simple repair code. How would wound closure with adhesive strips be reported? - correct answer ✅Wound closure utilizing adhesive strips as the sole repair material is coded using the appropriate E/M code. How is modifier 32 utilized? - correct answer ✅For services related to MANDATED consultation and or related services by a 3rd party payer, governmental, legislative, or regulatory guidelines. In the NCCI edits, what does the number 9 represent? - correct answer ✅Modifiers are not applicable.
questions and answers
Any finding of non-compliant actions MUST be documented in the compliance files and should include: - correct answer ✅1. Date of Incident 2. Name of the reporting party 3. Name of the person responsible for taking action 4. The follow- up action taken What regulation is the penalty for violating the FCA increased by? - correct answer ✅The Federal Civil Penalties Inflation Adjustment Act (FCPIA). How long does HIPAA require medical records to be maintained? - correct answer ✅Six (6) years from the date of creation, or the date for which it was last in effect, whichever is later. When a correction is made in an EHR what must exist? - correct answer ✅The amendment, correction, or delayed entry must be distinctly identified. There must also be a way to provide reliable means to clearly identify the original content and the modified content. The person altering the record and the date of the revision must also be documented. Which section of an operative report would you expect to find the reason or medical necessity for the procedure? - correct answer ✅Indication for surgery. What is a covered entity? - correct answer ✅Health plans, clearinghouses, and any healthcare provider who transmits health information in electronic format. When does the global period start for surgery? - correct answer ✅The day before.
questions and answers
What action may result in a false claims act violation? - correct answer ✅The provider knowingly submits claims to Medicare for DME supplies not provided to Medicare beneficiaries. When a provider is excluded under the Exclusions Statute, what must a provider do at the end of the exclusionary period? - correct answer ✅The provider must reapply for reinstatement. What are the 4 MIPS categories? - correct answer ✅1. Quality 2. Promoting Interoperability 3. Improvement Activities 4. Cost How long does Medicare's Conditions of Participation (CoP) for hospitals require retention of records? - correct answer ✅Five (5) years after the closed cost report. When a lab report reveals an abnormal finding, what should be documented? - correct answer ✅The physician should circle the abnormal result to indicate it was seen and sign, and address the abnormality in the diagnosis and treatment plan. What are good parameters for a baseline audit? - correct answer ✅A random selection of 10-15 records per practitioner. What is "Incident-To"? - correct answer ✅Incident to services and supplies are those provided as an integral, although incidental, part of the physician's or nonphysician practitioner's personal professional services during diagnosis and treatment. Physicians, Nurse Practitioners (NPs), Certified Nurse-Midwives (CNMs), Clinical Nurse Specialists (CNSs), and Physician Assistants (PAs) are nonphysician practitioners who are authorized to have services provided by auxiliary personnel.
