Self Assessment Test
The following test is designed to help you measure how ready you are for AAPC's CPMA exam. Your results will be emailed to you along with recommendations to help you improve your readiness for the exam, if necessary.
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1. How many core elements are in an OIG compliance manual?
a. 5
b. 7
c. 9
d. 10
2. Having a published fee schedule that is lower than Medicare reimbursement rates for self-pay patients is an example of:
a. Abuse
b. Fraud
c. Acceptable billing practice
d. Violation of Stark law
3. A provider was audited and found in violation of the Medicare false claims act. His violation was of a severe nature and included a review of 42 charts representing an overpayment of $123,000. What is the Medicare penaltY repayment?
a. $438,000
b. $1,104,000
c. $165,000
d. $789,000
4. A practice was recently placed under a CIA as the result of an OIG audit. Who will perform the required audits, and for how long will the CIA be implemented?
I.
II.
III.
IV.
OAS
IRO
OIG
CMS
V.
VI.
VII.
VIII.
2 yrs
3 yrs
5 yrs
7 yrs
a. I and VII
b. IV and V
c. II and VII
d. III and VIII
5. The auditor noted that the claim form included a GA modifier. The auditor then asked for a copy of the ABN obtained. The service provided was an IPPE physical, which medical reimburses at $125. The ABN is noted to be completely appropriately, regarding the patient information, dates, and signature. Which of the following answers is acceptable for the patient responsibility on the ABN:
a. There are no specification requirements
b. $120-$130
c. $25-$225
d. The amount must be exact.
6. Which of the following services would not be considered part of a global surgical package?
a. Immunosuppressive therapy for a liver transplant patient
b. Admit H&P
c. Type and cross match for surgery
d. Extensive intraoperative wound irrigation
7. The NCCI edits are referred to when editing a surgical case being audited. Although the services are noted to be mutually exclusive, this may be a mute point if:
a. A -59 modifier was used
b. The audit was a commercial carrier and not a government payer
c. A -22 modifier identified the excessive work involved
d. An assist-at-surgery was used during the surgical service
8. An auditor is preparing to go onsite to a cardiothoracic surgeon's office to perform an audit. The auditor should be sure to:
I. Take her proper coding references (CPT, ICD-9, HCPCS books)
II. Take a copy of '97 guidelines since this is a specialty practice
III. Ask that PAR contracts be made available for reference during the audit
IV. Request a copy of their fee schedule
a. All of the above
b. I and II
c. I and III
d. II, III, and IV
9. The auditor is reviewing records for a critical care provider (intensivist). The following was found in a record:
Patient presented with respiratory failure to the ER via ambulance
Patient has chronic COPD
ER physician stabilizes patient upon arrival and places the patient on a ventilator
Patient is sent to the ICU for admission and is seen by the intensivist
The intensivist does not feel that the patient's vent settings are appropriate and makes modifications based on the findings of his exam and review of ER services
The intensivist documents his services were performed from 1:15 - 2:40 and positively documents that the patient was critical due to vent status caused by respiratory failure.
Based on this information, the intensivist's services should be billed as a:
a. Consult Service
b. Critical Care Services
c. Ventilator Management
d. Admission Services
Questions 10-13
Connect the findings with the system examined:
10. Pedal Pulses Normal
a. Constitutional Exam
b. Cardiovascular Exam
c. Musculoskeletal Exam
d. Neurological Exam
11. WNWD
a. Constitutional Exam
b. Cardiovascular Exam
c. Musculoskeletal Exam
d. Neurological Exam
12. Numbness and Tingling
a. Constitutional Exam
b. Cardiovascular Exam
c. Musculoskeletal Exam
d. Neurological Exam
13. Stable Gait
a. Constitutional Exam
b. Cardiovascular Exam
c. Musculoskeletal Exam
d. Neurological Exam
Questions 14-16
When scoring an E&M encounter, the HPI is noted as:
The patient presents with a history of 2-day rash to the right forearm. She thought it may be poison ivy since she tried using Calamine lotion with no relief. The itching is noted to be worsening.
The ROS is documented as:
The patient reports ROS as no fevers, no weight loss/gain, no other rashes or lesions to the exposed skin, and no ENT or respiratory complaints.
Answer the following regarding this documentation:
14. The HPI documents the skin system as a positive ROS. Can the skin system be counted as an ROS using the documentation "no other rashes or lesions to the exposed skin"?
a. No - counting the skin as both HPI and ROS would be double dipping
b. Yes - because the documentation regarding the system is about different areas and the skin is a large organ system.
c. None of the above
d. There is not enough information to properly answer
15. The HPI documentation supports:
a. A brief HPI which includes 1 element
b. A brief HPI which includes 1-3 elements
c. An extended HPI which includes 3 elements
d. An extended HPI which includes 4 or more elements
16. The ROS is documented as:
a. No ROS are documented
b. Problem pertinent ROS which includes 1 system
c. Extended ROS which includes 2-9 systems
d. Complete ROS which includes 10 or more systems
17. The record being audited for an LCSW is a psychotherapy session of a 15-year-old minor, and it was reported as 90805 and the record documents 25 minutes of psychotherapy. The auditor changes the code to 90804 because:
a. Time guidelines were not met
b. This provider is not allowed to bill for this level of service
c. The auditor is not correct, the 90805 is an acceptable service
d. This is not the correct code choice for a minor
Questions 18-20
Audit the following physical therapy services:
Ms. Jones returns for her bi-weekly session for chronic low back pain. We are now in week 2 of her therapy and she is progressing nicely. Today's therapy:
Manual Therapy X 24 minutes
Electric Stimulation X 9 minutes
Ice Pack X 17 minutes
Ms. Jones should return next week for her next therapy appointment.
Shannon Robinson, PT
Spencer White, PTA
The codes and units billed are:
-97110 GP X 2 units
-97032 GP X 1 unit
-97010 GP X 2 units
Answer the following:
18. Choose all of the following statements that are true
I. All CPT Codes are correctly billed
II. The modifier used is inappropriate for services performed by a physical therapist
III. The ice pack services do not represent 2 units
IV. Manual therapy time is not enough to support 2 units
a. I, II and IV
b. III and IV
c. I and III
d. I, II, III and IV
19. The service appears to have been performed by a PT and a PTA combined, but billed under the PT's info to CMS. This is acceptable provided:
a. The GP modifier was used to indicate a PTA was used as it was in this case
b. The rules of "8" were met by the PT prior to use of the PTA
c. CMS never recognizes services performed jointly by a PT and PTA
d. The services provided are extensive enough to meet the medical necessity of utilizing a PTA
20. A CMS auditor may declare these services as non-billable due to the lack of:
a. Total session time
b. A clearly defined diagnosis or reason for the therapy
c. The lack of goals of therapy being documented
d. There was no exam documented during this encounter
21. A patient presented for chemotherapy infusion. Upon assessment it was noted that the patient was dehydrated and would additionally need hydration therapy. The services provided were as follows:
Drug
Dose
Route
Start
Stop
Trexall
150 mg
IV
10:14
10:49
Normal Saline
1000 cc
IV
10:14
11:10
Phenergan
50 mg
IV Push
N/A
N/A
a. 96413, 96360, 96375, J9260x3, J7050x4, J2550x1
b. 96360, 96415, 96374, J9260x3, J7050x4, J2550x1
c. 96413, 96375, J9260x3, J7050x4, J2550x1
d. 96413, 96361, 96375, J9260x3, J7050x4, J2550x1
22. A baseline audit should include:
a. 5-10 charts per provider
b. 10-15 charts per provider
c. 15-20 charts per provider
d. 25 charts per provider
Questions 23-30
CPT Code
Medicare LOS
Medicare Distribution
Practice LOS
Practice Distribution
Practice $ Distribution
Medicare Distribution on Practice
Distribution Difference
Medicare $ Distribution on Practice
Distribution Difference in $'S
99211
51,567
4%
192
4%
$3,648.00
196.44
0%
$3,732.34
($84.34)
99212
261,329
24%
1,012
22%
$35,420.00
1077.9
1%
$37,726.38
($2,306.38)
99213
502,014
52%
3,067
67%
$147,216.00
2399.4
-15%
$115,171.01
$32,044.99
99214
380,275
17%
198
4%
$15,048.00
796.29
13%
$60,517.90
($45,469.90)
99215
106,138
2%
110
2%
$12,210.00
108.98
0%
$12,096.80
$113.20
Totals
1,301,323
100%
4,579
100%
$213,542.00
4579
0
$229,244.43
($15,702.43)
23. Interpret the following levels of service:
a. 99213 services are being overbilled
b. 99213 services are being underbilled
c. 99214 services are being overbilled
d. The practice is statistically billing on target.
24. What was the
Medicare Distribution %
based on the Levels of Service chart above:
a. Total Dollar amount the practice is over or under billing per CMS bell curve
b. Actual number of patients seen by the practice per CPT level of service
c. The CMS reported expectation of patient to level of service ratio
d. Total ratio difference between CMS and practice
25. What was the
Practice LOS
based on the Levels of Service chart above:
a. Total Dollar amount the practice is over or under billing per CMS bell curve
b. Actual number of patients seen by the practice per CPT level of service
c. The CMS reported expectation of patient to level of service ratio
d. Total ratio difference between CMS and practice
26. What was the
Distribution Difference in %
based on the Levels of Service chart above:
a. Total Dollar amount the practice is over or under billing per CMS bell curve
b. Actual number of patients seen by the practice per CPT level of service
c. The CMS reported expectation of patient to level of service ratio
d. Total ratio difference between CMS and practice
27. What was the
Distribution Difference in $
based on the Levels of Service chart above:
a. Total Dollar amount the practice is over or under billing per CMS bell curve
b. Actual number of patients seen by the practice per CPT level of service
c. The CMS reported expectation of patient to level of service ratio
d. Total ratio difference between CMS and practice
28. A
Retrospective Audit
corresponds to:
a. Audit post claim processing
b. Audit pre claim processing
c. Audit targeting one specific service
29. A
Focused Audit
corresponds to:
a. Audit post claim processing
b. Audit pre claim processing
c. Audit targeting one specific service
30. A
Prospective Audit
corresponds to:
a. Audit post claim processing
b. Audit pre claim processing
c. Audit targeting one specific service
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