10 free, exam-style Certified Professional Medical Auditor (CPMA) practice questions with answers and explanations. No signup required. Work through them below, then take the full free CPMA practice test to study every exam domain.
An internal audit reveals that a primary care physician appends modifier 25 to the office E/M code on every encounter where any minor procedure is performed - including routine joint injections preceded only by a brief assessment of the injection site. The MOST appropriate audit finding is:
Correct answer: B - Non-compliant: routine pre-procedure assessment is not a separately identifiable E/M service
A 68-year-old established patient presents to her primary care office for a scheduled follow-up. The provider documents two stable chronic conditions (hypertension and type 2 diabetes), reviews the most recent A1C result, and continues all current medications without changes. Total time on the date of encounter is 18 minutes. The MOST appropriate code for this visit is:
Correct answer: B - 99213 - low MDM based on stable chronic conditions with limited data
A compliance officer is evaluating two regulatory exposures: (a) a physician's spouse owns shares in a hospital to which the physician refers Medicare patients, and (b) the same physician was offered (and declined) a cash payment in exchange for referrals. Which statement BEST captures the PRIMARY legal distinction between the Stark Law and the Anti-Kickback Statute?
Correct answer: C - Stark is strict-liability civil law, while the AKS requires intent and is criminal
A nurse practitioner sees a Medicare patient in a physician's office for a NEW complaint of right-sided abdominal pain. The supervising physician - who has previously treated this patient for unrelated chronic hypertension - is in the office suite during the encounter. The visit is billed under the physician's NPI at 100% of the Medicare fee schedule. The MOST significant compliance issue is:
Correct answer: B - Incident-to is invalid because the physician did not initiate treatment for this new problem
A Medicare contractor performs a statistically valid random sample of 150 claims from a universe of 4,200 claims. After projecting the findings, the point estimate of overpayment is $284,000, with a 90% one-sided lower confidence limit of $217,500 and an upper confidence limit of $351,000. Under MPIM Chapter 8 guidance, the demanded repayment will typically be:
Correct answer: D - $217,500 - the lower confidence limit gives the provider the benefit of statistical doubt
During a compliance review, a hospital's compliance officer discovers an arrangement with a referring physician that constitutes BOTH a technical Stark Law violation AND a potential Anti-Kickback Statute violation. To resolve both exposures through self-disclosure with the most efficient outcome, the hospital should pursue:
Correct answer: A - OIG Self-Disclosure Protocol - covers AKS and combined Stark plus AKS conduct
A general surgeon performs an open cholecystectomy on January 5. On January 22 - within the 90-day global period - the same patient returns to the office for evaluation of unrelated right knee pain following a fall at home. The surgeon performs and documents a separate problem-focused E/M for the knee complaint. To correctly report the knee E/M, the surgeon should append:
Correct answer: A - Modifier 24 - unrelated E/M by the same physician during a postoperative period
An auditor reviewing 30 randomly selected encounters from a single provider observes that the History of Present Illness, Review of Systems, and Physical Examination sections appear word-for-word identical across multiple visits for the same patient - and identical across different patients with similar chief complaints. The PRIMARY audit concern is:
Correct answer: C - EHR template use that may not reflect the actual content of each individual encounter
A gastroenterologist performs a diagnostic colonoscopy in the morning, then later the same day performs a separate, distinct esophagogastroduodenoscopy at a different session for a different clinical indication. NCCI procedure-to-procedure edits would normally bundle these services. To correctly report both procedures and override the bundling, CMS prefers the use of:
Correct answer: D - Modifier XE - separate encounter, distinct from the other reported service
An auditor is reviewing an inpatient admission dated March 15, 2024. The admitting hospitalist documents the encounter using time-based selection, recording exactly 50 minutes of total time on the date of admission. No MDM-based level is documented. Under the 2023 E/M guidelines, the appropriate code is:
Correct answer: A - 99221 - initial hospital inpatient/observation, 40 minutes must be met or exceeded
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