CPCO Study Guide with Complete Solutions Rated A
One of the most important elements of an ettective com-
pliance program is to have a compliance oflcer or com- empowered
mittee who is .
If an employee, provider or anyone that deals with Federal
or State healthcare dollars has intent to receive payment
fraud
for services not legitimately rendered this is considered
?
Joan, as an employee of a healthcare organization, has
to report erroneous conduct, without reper- duty
cussions, so that it may be corrected immediately
person who exposes misconduct, alleged dishonest or
illegal activity occurring in an organization is called relator
a ?
The compliance program will flounder if employees of the laws and regulations that pertain to their specific job de-
organization are not aware of ? scriptions
When physicians (or their statt) make billing mistakes and
Send a refund
errors the most important thing to do is ?
Judy is the Compliance Oflcer for Apple Medical Group.
The practice is a small group of providers. Judy wants to Post notices of up-to-date compliance information on the
have an open door policy as suggested by the OIG, thus employee bulletin board
she will?
Participants in the Federal healthcare programs have an
detects and prevent fraudulent, abusive and wasteful ac-
obligation to take measures, such as instituting a compli-
tivities
ance program, to ?
Tim, the Compliance Oflcer for XYZ Community Hospital,
CEO or Board
should report to whom?
The biller at XYZ Community Hospital wants to win the
award every month for posting the most insurance checks. double billing
Instead of giving the claims 30-60 days to clear, she bills
, CPCO Study Guide with Complete Solutions Rated A
them again at the end of the month. This is an example
of?
The OIG has described seven basic components of an ef-
fective compliance program for a small physician practice Federal Sentencing Guidelines
that are based from the ?
Kim, Compliance Oflcer for ABC Provider Group, created
a compliance plan and policy a year ago. While reviewing created a big risk of the group and Kim needs to make
the groups Baseline Audits it comes to her attention that sure that everyone knows about the risk of not following
many of the statt have decided NOT to follow the compli- the compliance plan
ance plan. The Non-Compliance has ?
A high-level statement or plan that embraces an or-
ganization's general beliefs, goals, objectives and ac-
policy
ceptable procedure for a specified subject area is a
?
Kim is the Compliance Oflcer for ABC Provider Group.
Kim has read the OIG Compliance Program Guidance
that acknowledges patient care as the first priority of a A "patients first"
physician practice. As the Compliance Oflcer (CO), Kim
should implement what type of compliance model?
It is important to educate employees of the methods they
may utilize to directly notify and communicate issues of
intra-oflce or USPS mail
suspected areas of non-compliance. What is considered
a best practice method of anonymous reporting?
Tim at XYZ wants to conduct a baseline audit to help areas of the billing department that might be in compli-
determine? ance
When the term Open Door Policy is used in reference to The Compliance Oflcer is accessible to all employees via
the Ettective Communication, what is this referring to? many methods of communication
When Kim from ABC Provider Group is conducting a risk
the Oflce of Inspector General's Annual Work Plan
assessment, one of the most important and key sources
, CPCO Study Guide with Complete Solutions Rated A
of information that Kim as the Compliance Oflcer should
utilize is .
The mission statement of the healthcare organization and
a statement of why they are in business are also known as The Code of conduct
?
How often should the Tim, Compliance Oflcer for XYZ
Community Hospital update the compliance program and As laws and regulations change; and at least annually
plan?
After an employee receives their initial training regarding
the practice/organization Compliance Program what is Perform a baseline assessment of the employee's compe-
the next step the compliance oflcer should take to protect tency scores to determine if additional training is required
the practice against potential noncompliance activity?
ABC Provider Group and Apple Medical Group agree to
pool their resources for the purpose of accomplishing a Joint ventures
specific task. This is called .
The following is not a level of non-compliance: Mistake in billing
For potential criminal violations, a practice should have
Is well versed in Healthcare Fraud and Abuse law
immediate discussions with a criminal attorney who
The Compliance Oflcer's main two responsibilities are
to the practice/organization's compliance develops and then implement
program.
Judy is the Compliance Oflcer for Apple Medical Group.
The providers of the group ask Judy to design a new Com-
pliance Plan. Should Judy ask some other practices in town No, compliance programs need to be tailored to fit the
for a copy of their Compliance Plan? Do all Compliance unique needs of every organization or physician practice
Programs have to be the same regardless of the practice
size or specialty? Why?
United States Sentencing Commission
, CPCO Study Guide with Complete Solutions Rated A
USSC is important as it related to the Federal Sentencing
Guidelines and thus related to the core elements of com-
pliance. What does the USSC acronym stand for?
Kathy, the Compliance Oflcer at a small provider oflce, is
notified that a non-English speaking patient will be arriv-
ing today. A LEP person/patient who needs an interpreter at no cost to the patient or insurance carrier
to translate to and from the person's primary language
must be provided.
In addition to hospitals, what other type of facility did the
OIG provide supplemental compliance program guidance Nursing Facilities
for?
What is (are) considered a significant element(s) in fraud? Knowingly and Intent
Department of Labor requires compliance with employee
FLSA, OSHA, CRA, ERISA
and employer laws including:
Which government branch was created to fight waste,
fraud and abuse in all federal health care programs es- Oflce of Inspector General (OIG)
pecially Medicare, Medicaid?
Dr. X is a very through provider. He always runs a full blood
panel on each patient every year for their physical. This is Waste
an example of:
The current strategy for the DOJ includes all of the follow-
Ensure the privacy of patient records with the use of HIPAA
ing except:
Which options are key elements for an ettective Compli-
ance Program?
I. Conducting external auditing and monitoring.
II. Implementing compliance and practice standards. II, III, V-VII
III. Designating a Compliance Oflcer or contact.
IV. Outsourcing appropriate training and education.
V. Responding appropriately to detected ottenses and
One of the most important elements of an ettective com-
pliance program is to have a compliance oflcer or com- empowered
mittee who is .
If an employee, provider or anyone that deals with Federal
or State healthcare dollars has intent to receive payment
fraud
for services not legitimately rendered this is considered
?
Joan, as an employee of a healthcare organization, has
to report erroneous conduct, without reper- duty
cussions, so that it may be corrected immediately
person who exposes misconduct, alleged dishonest or
illegal activity occurring in an organization is called relator
a ?
The compliance program will flounder if employees of the laws and regulations that pertain to their specific job de-
organization are not aware of ? scriptions
When physicians (or their statt) make billing mistakes and
Send a refund
errors the most important thing to do is ?
Judy is the Compliance Oflcer for Apple Medical Group.
The practice is a small group of providers. Judy wants to Post notices of up-to-date compliance information on the
have an open door policy as suggested by the OIG, thus employee bulletin board
she will?
Participants in the Federal healthcare programs have an
detects and prevent fraudulent, abusive and wasteful ac-
obligation to take measures, such as instituting a compli-
tivities
ance program, to ?
Tim, the Compliance Oflcer for XYZ Community Hospital,
CEO or Board
should report to whom?
The biller at XYZ Community Hospital wants to win the
award every month for posting the most insurance checks. double billing
Instead of giving the claims 30-60 days to clear, she bills
, CPCO Study Guide with Complete Solutions Rated A
them again at the end of the month. This is an example
of?
The OIG has described seven basic components of an ef-
fective compliance program for a small physician practice Federal Sentencing Guidelines
that are based from the ?
Kim, Compliance Oflcer for ABC Provider Group, created
a compliance plan and policy a year ago. While reviewing created a big risk of the group and Kim needs to make
the groups Baseline Audits it comes to her attention that sure that everyone knows about the risk of not following
many of the statt have decided NOT to follow the compli- the compliance plan
ance plan. The Non-Compliance has ?
A high-level statement or plan that embraces an or-
ganization's general beliefs, goals, objectives and ac-
policy
ceptable procedure for a specified subject area is a
?
Kim is the Compliance Oflcer for ABC Provider Group.
Kim has read the OIG Compliance Program Guidance
that acknowledges patient care as the first priority of a A "patients first"
physician practice. As the Compliance Oflcer (CO), Kim
should implement what type of compliance model?
It is important to educate employees of the methods they
may utilize to directly notify and communicate issues of
intra-oflce or USPS mail
suspected areas of non-compliance. What is considered
a best practice method of anonymous reporting?
Tim at XYZ wants to conduct a baseline audit to help areas of the billing department that might be in compli-
determine? ance
When the term Open Door Policy is used in reference to The Compliance Oflcer is accessible to all employees via
the Ettective Communication, what is this referring to? many methods of communication
When Kim from ABC Provider Group is conducting a risk
the Oflce of Inspector General's Annual Work Plan
assessment, one of the most important and key sources
, CPCO Study Guide with Complete Solutions Rated A
of information that Kim as the Compliance Oflcer should
utilize is .
The mission statement of the healthcare organization and
a statement of why they are in business are also known as The Code of conduct
?
How often should the Tim, Compliance Oflcer for XYZ
Community Hospital update the compliance program and As laws and regulations change; and at least annually
plan?
After an employee receives their initial training regarding
the practice/organization Compliance Program what is Perform a baseline assessment of the employee's compe-
the next step the compliance oflcer should take to protect tency scores to determine if additional training is required
the practice against potential noncompliance activity?
ABC Provider Group and Apple Medical Group agree to
pool their resources for the purpose of accomplishing a Joint ventures
specific task. This is called .
The following is not a level of non-compliance: Mistake in billing
For potential criminal violations, a practice should have
Is well versed in Healthcare Fraud and Abuse law
immediate discussions with a criminal attorney who
The Compliance Oflcer's main two responsibilities are
to the practice/organization's compliance develops and then implement
program.
Judy is the Compliance Oflcer for Apple Medical Group.
The providers of the group ask Judy to design a new Com-
pliance Plan. Should Judy ask some other practices in town No, compliance programs need to be tailored to fit the
for a copy of their Compliance Plan? Do all Compliance unique needs of every organization or physician practice
Programs have to be the same regardless of the practice
size or specialty? Why?
United States Sentencing Commission
, CPCO Study Guide with Complete Solutions Rated A
USSC is important as it related to the Federal Sentencing
Guidelines and thus related to the core elements of com-
pliance. What does the USSC acronym stand for?
Kathy, the Compliance Oflcer at a small provider oflce, is
notified that a non-English speaking patient will be arriv-
ing today. A LEP person/patient who needs an interpreter at no cost to the patient or insurance carrier
to translate to and from the person's primary language
must be provided.
In addition to hospitals, what other type of facility did the
OIG provide supplemental compliance program guidance Nursing Facilities
for?
What is (are) considered a significant element(s) in fraud? Knowingly and Intent
Department of Labor requires compliance with employee
FLSA, OSHA, CRA, ERISA
and employer laws including:
Which government branch was created to fight waste,
fraud and abuse in all federal health care programs es- Oflce of Inspector General (OIG)
pecially Medicare, Medicaid?
Dr. X is a very through provider. He always runs a full blood
panel on each patient every year for their physical. This is Waste
an example of:
The current strategy for the DOJ includes all of the follow-
Ensure the privacy of patient records with the use of HIPAA
ing except:
Which options are key elements for an ettective Compli-
ance Program?
I. Conducting external auditing and monitoring.
II. Implementing compliance and practice standards. II, III, V-VII
III. Designating a Compliance Oflcer or contact.
IV. Outsourcing appropriate training and education.
V. Responding appropriately to detected ottenses and
