Download CPMA Practice Test C with 100% Correctly Solved Answers and more Exams Nursing in PDF only on Docsity! CPMA PRACTICE TEST C WITH 100% CORRECTLY SOLVED ANSWERS. When auditing operative notes, the auditor will expect to see documentation from all of the following except --Answer-- Surgical assistants According to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), an outside auditor must sign which of the following agreements prior to reviewing and auditing any medical records? --Answer-- Business Associate Agreement The HIPAA Privacy Rule defines "minimum necessary" as typically requiring healthcare employees to --Answer-- Follow policies and procedures developed by the covered entity which limit use and disclosure of PHI to that which is needed to accomplish the intended purpose to perform the duties of their job When auditing an ENT practice, you discover the practice uses an EMR. Which of the following options would you look for when reviewing documents created in the electronic medical record or notes created using templates that may be indicators of misuse? --Answer-- Complete medical histories on each visit, diagnosis driven by clinical picture, repetitious notes not relevant to presenting problem State law will take precedence over HIPAA under which of the following circumstances --Answer-- If HIPAA is less restrictive than state law When providing a prescription for a patient, the education of the patient (including side effects and supporting documentation) in the medical record that the information was reviewed is based on which of the following standards? --Answer-- Joint Commission standards A deliberate misrepresentation of facts to gain unauthorized benefits is the definition of --Answer-- Fraud What is an action resulting in unnecessary costs, whether directly or indirectly, to a federal healthcare plan considered? --Answer-- Abuse When responding to a subpoena for medical records, which of the following documents would likely NOT be required to be copied and submitted: -- Answer-- Signed authorization for release of information Dr. Black receives a demand letter from the OIG stating the sanctions are sought under CMP for claims submitted by Dr. Black. He asks you, his auditor, to review the letter and the claims that are under scrutiny. It is determined that Dr. Black should not agree with the demand letter. You recommend that Dr. Black: --Answer-- Request a hearing before an HHS administrative court judge An effective compliance plan attributes to which of the following: --Answer-- Better informed employees Reduced risk of criminal sanctions, or civil penalties Effective operations and increased compliance with both federal and state laws A physician asks you, her auditor, what the specific difference is between 1995 and 1997 versions of documentation guidelines. Your response would be: --Answer-- Exam elements Which statement is TRUE regarding appending modifier 78 to a claim for a service provided to a Medicare beneficiary? --Answer-- When modifier 78 is appended, only the intraoperative percentage is paid and no new global period begins. Which scenario supports medical necessity for critical care services? -- Answer-- Care given to a patient in renal and respiratory failure. A GI physician begins a diagnostic endoscopy. The physician identifies some concerning lesions and makes the decision to perform an open procedure the following week. Can both procedures be reported and if so, what modifier should be appended? --Answer-- Yes, report both procedures with modifier 58 As an auditor you are tasked with performing a random selection of the medical and surgical services performed by the three new providers who joined the practice six months ago. This would be considered what type of audit? --Answer-- Baseline audit Sandra Keller works for an internal medicine practice. As part of the practice's compliance plan, she has been given the responsibility to perform an audit of the top five surgeries performed by the group at Hill Dale Hospital in the past year. How will Ms. Keller determine what types of services to review for this physician group? --Answer-- Run a utilization report of all
