Prepare to pass the CPMA with medical-record auditing practice

During a compliance audit, a facility defines its legal health record (LHR) as all documents generated within the EHR plus scanned paper consents. A patient requests access to a pathology report maintained by an affiliated reference laboratory that is not interfaced into the EHR but was used for treatment decisions. Which statement best describes what the organization must provide?

Tap an answer to reveal the correct answer, rationale and source.

• A. The legal health record and designated record set are identical; external reports cannot be part of either set.
• B. The patient may access the pathology report through a separate business associate agreement with the laboratory.
• C. Documents stored in the EHR constitute the designated record set; the external pathology report from an affiliated reference laboratory is outside the organization's custody and need not be disclosed even when used for treatment decisions.
• D. The designated record set must include records the entity maintains and uses for care decisions, including external pathology reports relied upon even if not stored in the EHR.

A physician bills a high-level in-office visit for a stable hypertension patient seen for a routine medication refill with no new complaints, no exam changes, and minimal counseling. Which compliance risk is most evident?

Tap an answer to reveal the correct answer, rationale and source.

• A. Missing informed consent documentation for the visit
• B. Upcoding relative to the documented work and complexity
• C. Incorrect place-of-service code reported for a telehealth visit
• D. Failure to report a separate procedure on the same day

A billing analyst calculates expected Medicare physician payment as total relative value units multiplied by a published dollar multiplier. Which element completes the formula?

Tap an answer to reveal the correct answer, rationale and source.

• A. DRG relative weight
• B. Capitation rate
• C. Conversion factor
• D. APC weight