CPCO Chapter 1 Review ACTUAL UPDATED QUESTIONS AND CORRECT
ANSWERS
Dr. Smith had some billing issues at his medical office. He Certification of Compliance Agreement in which providers agree to continue
agreed to work with the OIG to correct the issues. What to operate their existing compliance program.
does the term "CCA" refer to so that you (the Compliance
Officer) can explain to Dr. Smith? Response Feedback: CCA is a Certification of Compliance Agreement which
requires providers to certify they will continue to operate their existing
compliance programs for a fixed term.
Hospital compliance guidance was published by the OIG 2005
in February 1998. When was the supplemental
compliance guidance for hospitals published? Response Feedback:
Compliance Program Guidance for Hospitals (63 Fed. Reg. 8987; February
23, 1998)
Supplemental Compliance Program Guidance for Hospitals (70 Fed. Reg.
4858; January 31, 2005)
Kim is the Compliance Officer for a large provider group. Abuse
One of the billers for the group enters codes from the
encounter form every evening before she goes home Response Feedback:
and then finishes in the morning when she returns. She CMS goes on to define abuse as "practices that, either directly or indirectly,
often enters an encounter twice. She usually catches the result in unnecessary costs to the Medicare Program." Improper billing
mistake when the insurance checks are sent to the office practices.
and returns the overpayment to the insurance carrier. This
is an example of:
Justin works at the local hospital in the billing department. Office of Inspector General (OIG)
He wants to learn more about the agency that fights
Medicare Fraud. Which is the best answer below? Response Feedback:
Since its 1976 establishment, OIG has been at the forefront of the Nation's
efforts to fight waste, fraud and abuse in Medicare, Medicaid and more than
300 other HHS programs.
According to Inspector General Daniel Levinson, what provider has a robust and effective compliance program
can help reduce enforcement on a provider from a CIA
to a CCA? Response Feedback:
Inspector General Daniel Levinson disseminated an Open Letter to
Healthcare Providers in 2006, in which he discussed the current
enforcement and noted that, "many providers have independently developed
robust and effective compliance programs, which include internal auditing
mechanisms. In appropriate cases, we have agreed to reduce the obligation
on providers settling health care fraud matters by entering into Certification
of Compliance Agreements (CCAs), rather than more extensive CIAs.
In addition to hospitals, what other type of facility did the Nursing Facilities
OIG provide supplemental compliance program
guidance for? Response Feedback:
Supplemental compliance program guidance was published for nursing
facilities in September 2008.
, CPUP was the first large fraud case that involved a Pennsylvania
teaching hospital where Residents and Fellows worked
and was located in: Response Feedback:
Pennsylvania. The clinical practices of the University of Pennsylvania (CPUP)
was the first major audit that targeted teaching hospitals in 1995.
Department of Labor requires compliance with employee FLSA, OSHA, CRA, ERISA
and employer laws including:
Response Feedback:
The Department of Labor requires compliance with the employee and
employer laws including the Fair Labor Standards Act (FLSA), Occupational
Safety and Health Act (OSHA), Civil Rights Act (CRA), and Employee
Retirement and Income Safety Act (ERISA).
Jill works for ABC Family Practice. Jill wants to find out Office of Civil Rights (OCR)
more about the HIPAA Privacy Rule and Security Rule Response Feedback:
provisions. Which office or department would Jill The OCR is responsible for enforcing the HIPAA Privacy Rule and Security
contact? Rule provisions. It also oversees the provisions of the Civil Rights Act of
1964 as it applies to Limited English Proficiency (see below), the
confidentiality provisions of the Patient Safety Act and Rule, and the Church
Amendments, section 245 of the Public Health Service Act, and the Weldon
Amendment, collectively known as the Federal Health Care Provider
Conscience Protection Laws.
What does the acronym LEP stand for? Limited English Proficiency
Response Feedback:
Limited English Proficiency (LEP)
The OIG has developed a five-principle strategy to Scrutinize individuals and entities that are participating as providers and
combat healthcare Fraud, Waste, and Abuse. Which of suppliers after their enrollment in healthcare programs.
these options is NOT included in these principles?
Response Feedback:
The OIG's Five-Principle Strategy to combat healthcare fraud, waste, and
abuse include:
1 - Enrollment - Scrutinize individuals and entities that want to participate
as providers and suppliers prior to their enrollment in healthcare programs;
2 - Payment - Establish payment methodologies that are reasonable and
responsive to changes in the marketplace;
3 - Compliance - Assist healthcare providers and suppliers in adopting
practices that promote compliance with program requirements, including
quality and safety standards;
4 - Oversight - Vigilantly monitor programs for evidence of fraud, waste,
and abuse; and
5 - Response - respond swiftly to detect fraud, impose sufficient
punishment to deter others, and promptly remedy program vulnerabilities.
ANSWERS
Dr. Smith had some billing issues at his medical office. He Certification of Compliance Agreement in which providers agree to continue
agreed to work with the OIG to correct the issues. What to operate their existing compliance program.
does the term "CCA" refer to so that you (the Compliance
Officer) can explain to Dr. Smith? Response Feedback: CCA is a Certification of Compliance Agreement which
requires providers to certify they will continue to operate their existing
compliance programs for a fixed term.
Hospital compliance guidance was published by the OIG 2005
in February 1998. When was the supplemental
compliance guidance for hospitals published? Response Feedback:
Compliance Program Guidance for Hospitals (63 Fed. Reg. 8987; February
23, 1998)
Supplemental Compliance Program Guidance for Hospitals (70 Fed. Reg.
4858; January 31, 2005)
Kim is the Compliance Officer for a large provider group. Abuse
One of the billers for the group enters codes from the
encounter form every evening before she goes home Response Feedback:
and then finishes in the morning when she returns. She CMS goes on to define abuse as "practices that, either directly or indirectly,
often enters an encounter twice. She usually catches the result in unnecessary costs to the Medicare Program." Improper billing
mistake when the insurance checks are sent to the office practices.
and returns the overpayment to the insurance carrier. This
is an example of:
Justin works at the local hospital in the billing department. Office of Inspector General (OIG)
He wants to learn more about the agency that fights
Medicare Fraud. Which is the best answer below? Response Feedback:
Since its 1976 establishment, OIG has been at the forefront of the Nation's
efforts to fight waste, fraud and abuse in Medicare, Medicaid and more than
300 other HHS programs.
According to Inspector General Daniel Levinson, what provider has a robust and effective compliance program
can help reduce enforcement on a provider from a CIA
to a CCA? Response Feedback:
Inspector General Daniel Levinson disseminated an Open Letter to
Healthcare Providers in 2006, in which he discussed the current
enforcement and noted that, "many providers have independently developed
robust and effective compliance programs, which include internal auditing
mechanisms. In appropriate cases, we have agreed to reduce the obligation
on providers settling health care fraud matters by entering into Certification
of Compliance Agreements (CCAs), rather than more extensive CIAs.
In addition to hospitals, what other type of facility did the Nursing Facilities
OIG provide supplemental compliance program
guidance for? Response Feedback:
Supplemental compliance program guidance was published for nursing
facilities in September 2008.
, CPUP was the first large fraud case that involved a Pennsylvania
teaching hospital where Residents and Fellows worked
and was located in: Response Feedback:
Pennsylvania. The clinical practices of the University of Pennsylvania (CPUP)
was the first major audit that targeted teaching hospitals in 1995.
Department of Labor requires compliance with employee FLSA, OSHA, CRA, ERISA
and employer laws including:
Response Feedback:
The Department of Labor requires compliance with the employee and
employer laws including the Fair Labor Standards Act (FLSA), Occupational
Safety and Health Act (OSHA), Civil Rights Act (CRA), and Employee
Retirement and Income Safety Act (ERISA).
Jill works for ABC Family Practice. Jill wants to find out Office of Civil Rights (OCR)
more about the HIPAA Privacy Rule and Security Rule Response Feedback:
provisions. Which office or department would Jill The OCR is responsible for enforcing the HIPAA Privacy Rule and Security
contact? Rule provisions. It also oversees the provisions of the Civil Rights Act of
1964 as it applies to Limited English Proficiency (see below), the
confidentiality provisions of the Patient Safety Act and Rule, and the Church
Amendments, section 245 of the Public Health Service Act, and the Weldon
Amendment, collectively known as the Federal Health Care Provider
Conscience Protection Laws.
What does the acronym LEP stand for? Limited English Proficiency
Response Feedback:
Limited English Proficiency (LEP)
The OIG has developed a five-principle strategy to Scrutinize individuals and entities that are participating as providers and
combat healthcare Fraud, Waste, and Abuse. Which of suppliers after their enrollment in healthcare programs.
these options is NOT included in these principles?
Response Feedback:
The OIG's Five-Principle Strategy to combat healthcare fraud, waste, and
abuse include:
1 - Enrollment - Scrutinize individuals and entities that want to participate
as providers and suppliers prior to their enrollment in healthcare programs;
2 - Payment - Establish payment methodologies that are reasonable and
responsive to changes in the marketplace;
3 - Compliance - Assist healthcare providers and suppliers in adopting
practices that promote compliance with program requirements, including
quality and safety standards;
4 - Oversight - Vigilantly monitor programs for evidence of fraud, waste,
and abuse; and
5 - Response - respond swiftly to detect fraud, impose sufficient
punishment to deter others, and promptly remedy program vulnerabilities.
