AAPC CPMA PRACTICE EXAM STUDY QUESTIONS AND ANSWERS (100% PASS), Exams of Nursing

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AAPC CPMA PRACTICE EXAM STUDY QUESTIONS

AND ANSWERS (100% PASS)

What elements must be in a medical record Patient ID, Assignment of Benefits, medical history, immunizations, physical exam, lab report, clinical impression, physician orders What is the minimum signature assignment of the author of entry in the medical record? First initial, Last Name and credentials Based on the JC accreditation guidelines for personal data, what 2 elements must be evident in the medical record? There must be a patient information sheet that contains biographical data, name, address, etc. along with authorization for treatment whether it is an office visit, diagnostic services or surgical procedure. What is the appropriate way to dispose of PHI that is no longer needed? Discard it in a locked shredding receptacle When must ABNs be signed? Far enough in advance that the beneficiary or representative has time to consider the options and make an informed decision.

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 H in CHEDDAR Patients can request copies of disclosure of PHI under HIPAA: For a six (6) year period of time When can a RAC extrapolate the overpayment(s) on claims? 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: Only appropriate if the two procedures are performed on separate lesions or at separate patient encounters.

True or False: The admitting physician must append modifier AI Principal physician of record to the admission code for Medicare beneficiaries True - even if only one provider A comprehensive audit is: sometimes referred to as a focused review, is an audit of a specified number of medical records in which a previous audit has identified problems based on procedure and/or diagnosis codes or other audit findings. A audit is the usual methodology when conducting a baseline audit. Random True or False: NCCI edits and MUE are controlling standards True The Summary of Audit findings should be: concise by providing most common findings, aggregate conclusions and key recommendations True or False: If a psychotherapy is notated like an E&M: history, exam, MDM including drug mgmt it is reported as an E&M

True How is RATS-STATS used by an auditor? Software used in performing statistical random samples and evaluating results. You are preparing to perform a surgical chart audit. Which of the following resources would you need in order to accurately conduct the audit? ICD- 10 - CM, CPT®, HCPCS Level II code books, NCCI edits, medical terminology book, global days, surgery audit tool, rules of insurance carriers Which statement is TRUE regarding appending modifier 78 to a claim for a service provided to a Medicare beneficiary? When modifier 78 is appended, only the intraoperative percentage is paid and no new global period begins. Incident To cannot be performed in a facility setting. True or False? TRUE What are the recommended number of charts to audit per provider and the minimum frequency of the audit according to the OIG Recommended Compliance Plan?

10 records per provider each year True or False: If hydration is main reason for infusion you would report 96360 first instead of the pushes. True True or False: When the same test is performed on different specimen(s) that uses the same CPT® code modifier 59 is appropriate to use True An analysis that provides the organization an overview of the deficit areas captured by a medical record audit is called what? An aggregate analysis provides an overview of the deficient areas for an organization. At a glance the practice can identify percentages of undercoding and upcoding as well as other coding errors. True or False: When a CRNA and a Anesthesiologist both have a part in the procedure and belong to the same practice they can both bill on the same claim TRUE What should an auditor review for an operation? The operative note, codes selected, payer payment policy and NCCI edits prior to claim submission

What information should be reported to the OIG in the Claims Review findings as part of an entity's Annual Report? Claims review methodology, statistical sampling documentation, and claim review findings The compliance program guidance (CPG) document identifies four risk areas most likely to affect a physician's practice. The risk areas include: Coding and billing, reasonable and necessary services, documentation, improper inducements True or False: Only one consult is reported on hospital admission. True. Otherwise use subsequent day codes for following consults Is reporting 14000 with 11401 unbundling? Yes according to CPT guidelines the excision of a benign lesion or malignant lesion is not separately reportable. Commercial and Government carriers audit medical records. Select the statement that is TRUE regarding commercial and government carriers.

Commercial carriers and Government carriers both use claims data to identify providers and services to audit. True or False: Anesthesia modifiers are only reported on aneshtesia codes. True True or False: Conscious sedation is considered anesthesia False When responding to a subpoena for medical records, which of the following documents would likely NOT be required to be copied and submitted: Signed authorization for release of information A provider performs two procedures that NCCI edits state should not be reported together. However if the NCCI edit does not allow use of NCCI- associated modifiers to bypass it and the documentation supports and qualifies as an unusual procedure, the physician may report the column one HCPCS/CPT® procedure code of the NCCI edit with which modifier? modifier 22

When performing a retrospective audit, the auditor will need to have which of the following materials? patient's medical record, the appropriate audit form, coding manuals, EOB or Medicare RA, payer policies and the CMS 1500 claim form. A provider receives denials from a private payer for E/M services performed on the same date as a minor procedure. You review documentation for 25 records and the payer contract which states the provider must follow CMS coding guidelines. You determine that 20 of the records have appropriate documentation to support both E/M and the procedure and were coded correctly when the claim was originally submitted. You submit an appeal for the 20 dates of service that are supported by documentation. To support you findings, you will include in the appeal a letter reporting your findings, claim forms, copies of documentation, EOB copies and NCCI policy manual for modifier 25