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CPMA 2026 QUESTIONS AND
ANSWERS | A+ GRADED | WITH
EXPERT SOLUTIONS
Under CIA, 50 sampling units are reviewed. What is the sample referred as? A. Discovery Sample B. Initial Sample C. Complete Sample D. Selective Sample - correct answer -A. Discovery Sample (used to determine the net financial error rate)
Which may result in false claims act violation? A. A provider routinely waives the copay for MCR beneficiaries B. A provider accepts insurance only payments from MCR beneficiaries C. A provider submits claims to MCR for DME supplies not provided to MCR beneficiaries D. A provider knowingly submits claims to MCR for DME supplies not provided MCR beneficiaries - correct answer -D. A provider knowingly submits claims to MCR for DME supplies not provided MCR beneficiaries
A Qui Tam Relator may receive what type of award for bringing a case in which the government intervenes? A. 15-25% of money recovered B. 10-15% of money recovered C. 10-15% of total claim amount D. 15-40% of total claim amount - correct answer -A. 15-25% of money recovered
What is the look back period for FFS Recovery Auditors reviewing claims? A. 60 days B. 5 years C. 15 year D. 3 years - correct answer -D. 3 years
The OIG lists potential risk areas for physician groups in the compliance plan guidance. Which option is listed as a risk area? A. Under Coding B. Unbundling C. Overuse of E/M Codes
Which of the following best represents an example of fraud? A. Billing for services at a higher level than provided or necessary B. Waiving cost-shares or deductibles C. A pattern of claims for services not medically necessary D. Failure to maintain adequate medical or financial records - correct answer -A. Billing for services at a higher level than provided or necessary
When a physician is banned from participating in any Federal or State health care program by the OIG under the Exclusion Statue, what is the minimum term of exclusion applies? A. 10 years B. 5 Years C. 60 Days D. 1 year - correct answer -B. 5 Years
Which of the following actions is an example of fraud or misconduct subject to the False Claims act? A. The provider receives a lab result back and documents in the patient's chart that the lab result indicates a malignant lesion B. The provider alters all medical records for lesion excisions to support the level he reported on the claim
C. The provider determines he has forgotten to document the size of the one lesion and makes an addendum D. The provider reviews his records and determines the documentation supports the calims. - correct answer -B. The provider alters all medical records for lesion excisions to support the level he reported on the claim
You Audit provider who is consistently reporting multiple units of CPT code 11042. What references can you use to show the provider multiple units of CPT code 11042 is not allowed and explain how it should be reported?
a. CPT codebook and MUE table.
b. CPT codebook and NCCI edits
c. MUE table only
d. HCPCS codebook and NCCI edits - correct answer -a. CPT codebook and MUE table.
The OIG Compliance Program Guidance for individual and small group identifies 4 risk areas affecting physicians.
D. A person who brings a civil action for a violation for him/herself and for the US government - correct answer -D. A person who brings a civil action for a violation for him/herself and for the US government
When a IRO is completing a CIA Discovery Sample, how many sampling units are reviewed? A. 200 B. 100 C. 50 D. 10 - correct answer -C. 50
What program is provided by the OIG to assist in random selection of charts for a Discovery Sample? A. The OIG provides a statistical sampling called RAT-STATS B. The OIG provides an on-site investigator to randomly select the charts for the discovery sample C. The OIG recommends using excel for sampling D. The OIG does not have a program to assist in random sampling - correct answer -A. The OIG provides a statistical sampling called RAT-STATS
What is CoP? A. Medicaid's Coordination of Physician Groups B. Commercial Programs C. MCR Conditions of Participation D. Tri-Care's Compliance of Physician Guidance - correct answer -C. MCR Conditions of Participation
When a Discovery Sample is performed, what error rate requires a full sample to be reviewed? A. Error rate that exceeds 25% B. Error rate that exceeds 10% C. Error rate that exceeds 5% D. Error rate that exceeds 50% - correct answer -C. Error rate that exceeds 5% (a full sample must be reviewed, along with a systems review)
What are the MIPS Performance Categories? I. Costs II. Promoting Interoperability III. Quality IV. Improvement Activities
Responding promptly to detected offenses and developing corrective action.
A corporate integrity agreement (CIA) has core requirements. Which option is NOT one of the core requirements? A. Restrict employment of ineligible persons B. Develop written standards and policies C. Provide an implementation report and annual reports to OIG on the status of the entity's compliance activities D. Hire an OIG employee to oversee the compliance efforts - correct answer -D. Hire an OIG employee to oversee the compliance efforts (lasts 5 years and includes requirements to: Hire a compliance officer/appoint compliance committee Develop written standards and policies Implement a comprehensive employee training program Retain an independent review organization to conduct annual reviews Establish a confidential disclosure program Restrict employment of ineligible persons Report overpayments, reportable events, and ongoing investigations/legal proceedings Provide an implementation report and annual reports to OIG of the status of the entity's compliance activities
What review requires medical records? A. Semi-automated B. Complex C. Automated D. Independent - correct answer -B. Complex (automated does not require medical records)
What is an automated review? A. Review based on data and potential human review of a medical record or other documentation B. Medical records are required for the review C. Review based solely on the submitted claims and regulatory guidelines. No medical records are needed. D. Review is based solely on denials received. - correct answer - C. Review based solely on the submitted claims and regulatory guidelines. No medical records are needed. (Improper payments are determined based solely on submitted claims and regulatory guidelines such as NCD, LCDs and CMS Manuals)
D. Self-referrals to designated health services - correct answer - D. Self-referrals to designated health services
When a provider is excluded under the Exclusions Statute, what must he or she do at the end of the exclusionary period? A. The provider cannot be reinstated once excluded B. The provider must apply for reinstatement C. The provider is automatically reinstated D. The provider must apply for a group provider number - correct answer -B. The provider must apply for reinstatement
The false claims act (FCA) allows for reduced penalties if a person in violation self-discloses if which conditions exist? A. there is no additional criminal prosecution, civil action, or administrated action with the respect to the violation B. the person furnishes all information about the violation within 30 days after which the defendant first obtained the information C. the person full cooperates with the investigation D. all of the above - correct answer -D. all of the above
What action would be considered fraud rather than abuse?
A. Increased level of E/M visits based on electronic health record documentation B A keying error C. A provider requiring the coding staff to intentionally code E/M services one level higher than documented D. A provider utilizing modifier 25 on all E/M visits reported with a minor procedure - correct answer -C. A provider requiring the coding staff to intentionally code E/M services one level higher than documented
In a corporate integrity agreement (CIA) does the OIG specify the Independent Review Organization to be used? A. No, the OIG does not have any input on the IRO uses under any circumstance B. No, the OIG does not specify the IRO to be used, but does retain the right to notify the provider if they must select a new IRO C. Yes, the specific IRO will be named in the CIA D. Yes, the CIA will identify 5 IROs that can be used for the CIA review - correct answer -B. No, the OIG does not specify the IRO to be used, but does retain the right to notify the provider if they must select a new IRO
What does the MUE table indicate?
A. A health plan, healthcare clearinghouse, and any healthcare provider who transmits health information in an electronic format. B. Any entity that transmits any information electronically C. A healthcare provider who sends only paper claims D. A health plan, healthcare clearinghouse, and any healthcare provider who transmits health information in any format. - correct answer -A. A health plan, healthcare clearinghouse, and any healthcare provider who transmits health information in an electronic format.
When referring to radiological services, what is the requirement for the images obtained? A. There are no specific requirements B. As long as there is a written report, the images are not important C. They only need to be retained if abnormalities are identified D. The actual images must be retained - correct answer -D. The actual images must be retained (it is also important to have a written report and an order)
Which one is not a term used for radiological review in a radiology report? A. Anteroposterior (AP) B. Prone
C. Swimmers D. Oblique (OBL) - correct answer -B. Prone (it is a body position)
What is identified in the indications portion of an operative note? A. Specific details about the surgery B. A brief history outlining the medical necessity for the procedure C. The outcome of the surgical procedure D. The provider and anesthesiologist performing the surgery - correct answer -B. A brief history outlining the medical necessity for the procedure
How long does HPAA require medical records be maintained? A. 6 years from the date of its creation or the date from which it was last in effect (whichever is later) B. 5 years past the date of death of the patient C. 10 years rom the date of its creation or the date from which it was last in effect (whichever is later) D. 5 years rom the date of its creation or the date from which it was last in effect (whichever is later) - correct answer -A. 6 years from the date of its creation or the date from which it was last in effect (whichever is later)
D. Health and Human Services Fraud Prevention Program - correct answer -A. Heath Care Fraud and Abuse Control Program
For therapy services, what is the reason for progress note? a. To indicate services were performed b. To provide justification for the medical necessity of treatment information. c. To serve as the plan of care d. To serve as the re-certification - correct answer -b. To provide justification for the medical necessity of treatment information.
How long does Medicare's Conditions of Participation (CoP) for hospitals require retention of medical records? A. 5 years after the closed cost report B. 20 years after the closed cost report C. 6 years after the closed cost report D. 1 year after the closed cost report - correct answer -A. 5 years after the closed cost report
Which one is NOT a requirement for financial penalties to be mitigated in a federal false claims act case?
A. No criminal prosecution, civil action, or administrative action has commenced with respect to the violation B. The person in violation fully cooperates with the investigation C. The person committing the violation self discloses within 30 days of knowing about the violation D. The person committing the violation decides to voluntarily opt out of the Medicare program - correct answer -D. The person committing the violation decides to voluntarily opt out of the Medicare program
A provider consistently charges a higher level E/M service than is documented to help cover the cost of his declining practice. Would this be fraud or abuse Why?
a. Abuse,charging one level higher on each visits does not show intent. b. Abuse; the provider's practice is common and therefore would not be considered fraudulent. c. Fraud; and over-coding of services would be considered fraudulent. d. Fraud; the provider intentionally over-coded to gain financially. - correct answer -d. Fraud; the provider intentionally over-coded to gain financially.
