(Passing score: 75% or higher required to receive CEU certificate)
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Question 1 of 15
Which of the following is the primary purpose of a payer audit?
To penalize providers for billing errors
To ensure documentation meets payer and clinical standards
To verify client satisfaction
To review clinical effectiveness only
Question 2 of 15
Which documentation element best demonstrates medical necessity?
Listing every coping skill discussed
Describing symptoms, treatment goals, and client progress
Repeating the same note for each session
New Choice
Question 3 of 15
Medicaid and Medicare auditors primarily review records for:
Missed appointments
Evidence of informed consent
Proof of medical necessity and accurate CPT coding
Therapist education level
Question 4 of 15
Which CPT code represents a 53+ minute psychotherapy session?
90832
90834
90837
90846
Question 5 of 15
Progress notes should typically be completed within how many hours of the session?
72–96 hours
24–48 hours
One week
Immediately after billing submission
Question 6 of 15
True or False: Using identical (cloned) progress notes for multiple clients is considered compliant if the services provided were similar
True
False
Question 7 of 15
Which of the following would likely trigger an audit?
Consistent CPT coding and documentation
Signed and dated treatment plans
Frequent billing of the same code without time documentation
Timely completion of progress notes
Question 8 of 15
In a United Healthcare or Commercial Risk Adjustment Audit, what do payers primarily evaluate?
Diagnosis coding accuracy (HCC) and documentation alignment
Client attendance rates
Therapy effectiveness surveys
Clinician marketing materials
Question 9 of 15
Which statement about audit preparedness is true?
It begins only after receiving an audit notice.
It requires consistent internal reviews and staff training.
It’s only relevant for Medicaid providers.
It focuses solely on billing.
Question 10 of 15
Which ethical principle applies when correcting a documentation error?
Delete the original note and rewrite it.
Ignore the error if the client improved.
Use an addendum explaining the correction with date and initials.
Backdate the note to avoid detection.
Question 11 of 15
What is the best first step when receiving an audit letter?
Contact the payer to argue the review
Panic and delete outdated notes
Review your internal audit checklist and gather requested documentation
Ignore the letter until the deadline approaches
Question 12 of 15
Which of the following is NOT part of an internal compliance system?
Monthly or quarterly chart reviews
Annual staff training on documentation
Random file audits
Allowing clinicians to choose their own documentation rules
Question 13 of 15
True or False: Progress notes must reflect both the intervention provided and the client’s response to the intervention.
Question 14 of 15
In ethical billing, clinicians should:
Bill for missed appointments to recover lost income
Bill only for services provided and documented
Increase session lengths for higher reimbursement
Bill under a supervisor’s license without disclosure
Question 15 of 15
Which of the following best describes the goal of this training?
To teach advanced therapy techniques
To help clinicians identify and correct compliance gaps to prevent audits
To train therapists on marketing their practices
To prepare therapists for licensure renewal exams