CSIA CERTIFICATION EXAM SCRIPT
VERIFIED QUESTIONS WITH COMPLETE
SOLUTION REVIEW
●● A. Promote an organizational culture that encourages ethical conduct
and a commitment to compliance with the law.
Answer: According to the Federal Sentencing Guidelines, "To have an
effective compliance and ethics program..., an organization shall
exercise due diligence to prevent and detect criminal conduct." The
FSGs also state organizations shall:
A. Promote an organizational culture that encourages ethical conduct
and a commitment to compliance with the law.
B. Implement mandatory compliance programs.
C. Perform annual audits to detect criminal conduct.
D. Immediately report evidence of misconduct to the authorities.
●● B. Tailor those materials to the physician practice where they will be
applied.
Answer: If a physician practice uses another entity's standards of
conduct, the practice must:
A. Implement the standards of conduct as received because they have
already been approved.
,B. Tailor those materials to the physician practice where they will be
applied.
C. Only select those standards that represent high risk issues for the
practice.
D. None of the above. Physician practices must create their own
standards of conduct. It would be a compliance violation to copy another
entity's standards of conduct.
●● B. For any services billed, documentation must be present in the
patient's medical record to support the services.
Answer: As the compliance contact for your physician practice, you are
charged with developing the policies and procedures related to coding
and billing. When developing these policies and procedures, which of
the following statements should be included?
A. If a new physician joins the practice and the new physician's NPI has
not been received, services performed should be reported using the
practice medical director's NPI.
B. For any services billed, documentation must be present in the
patient's medical record to support the services.
C. To avoid compliance risk, coding for E/M services should be based
solely on medical record documentation, even if it appears the level of
service is not warranted.
D. For denied services, billing staff should notify the physician to
change the reported diagnosis to allow for resubmission and payment of
the claim.
,●● D. Document the conversation and retain the records.
Answer: City Orthopedics, a large physician group practice employs
several physician assistants and nurse practitioners. There have been
several questions by the physicians on how incident to services should
be billed. The compliance officer has called the Medicare Administrative
Contractor for the practice and was given some information on how
incident to services should be billed. Because the practice will be relying
on the information received from the Medicare Administrative
Contractor, what steps should the compliance officer take at the
conclusion of the call according to the OIG Compliance Guidance for
Individual and Small Group Physician Practices?
A. Call someone else at the Medicare Administrative Contractor to
confirm the information received.
B. Send a letter to CMS to confirm the information provided by the
Medicare Administrative Contractor is correct.
C. Both A and B
D. Document the conversation and retain the records.
●● B. Be sure any timeframes or requirements listed can be
accomplished given the practice's resources.
Answer: Developing effective compliance policies and procedures is an
important part of any compliance program. To help your practice
mitigate compliance risk, policies and procedures should:
, A. Only be one page long to promote understanding by all staff.
B. Be sure any timeframes or requirements listed can be accomplished
given the practice's resources.
C. Be written by consultants because they are more familiar with the
variety of healthcare regulations that apply to the practice.
D. Both B and C
●● C. Verify accuracy of coding and reimbursement for the services
performed.
Answer: Select the best phrase from the list below to complete the
following policy statement: Centennial Medical Associates is committed
to following Federal, State, and Local laws, rules, guidelines, and
regulations. To promote this effort, Centennial Medical Associates will
perform claims audits at least on an annual basis to
____________________.
A. Maximize reimbursement for the services performed.
B. Optimize reimbursement for the services performed.
C. Verify accuracy of coding and reimbursement for the services
performed.
D. Ensure all services are submitted for reimbursement.
●● A. Reviewing reports to see that new employees and vendors have
been checked against the OIG's list of excluded individuals and entities.
VERIFIED QUESTIONS WITH COMPLETE
SOLUTION REVIEW
●● A. Promote an organizational culture that encourages ethical conduct
and a commitment to compliance with the law.
Answer: According to the Federal Sentencing Guidelines, "To have an
effective compliance and ethics program..., an organization shall
exercise due diligence to prevent and detect criminal conduct." The
FSGs also state organizations shall:
A. Promote an organizational culture that encourages ethical conduct
and a commitment to compliance with the law.
B. Implement mandatory compliance programs.
C. Perform annual audits to detect criminal conduct.
D. Immediately report evidence of misconduct to the authorities.
●● B. Tailor those materials to the physician practice where they will be
applied.
Answer: If a physician practice uses another entity's standards of
conduct, the practice must:
A. Implement the standards of conduct as received because they have
already been approved.
,B. Tailor those materials to the physician practice where they will be
applied.
C. Only select those standards that represent high risk issues for the
practice.
D. None of the above. Physician practices must create their own
standards of conduct. It would be a compliance violation to copy another
entity's standards of conduct.
●● B. For any services billed, documentation must be present in the
patient's medical record to support the services.
Answer: As the compliance contact for your physician practice, you are
charged with developing the policies and procedures related to coding
and billing. When developing these policies and procedures, which of
the following statements should be included?
A. If a new physician joins the practice and the new physician's NPI has
not been received, services performed should be reported using the
practice medical director's NPI.
B. For any services billed, documentation must be present in the
patient's medical record to support the services.
C. To avoid compliance risk, coding for E/M services should be based
solely on medical record documentation, even if it appears the level of
service is not warranted.
D. For denied services, billing staff should notify the physician to
change the reported diagnosis to allow for resubmission and payment of
the claim.
,●● D. Document the conversation and retain the records.
Answer: City Orthopedics, a large physician group practice employs
several physician assistants and nurse practitioners. There have been
several questions by the physicians on how incident to services should
be billed. The compliance officer has called the Medicare Administrative
Contractor for the practice and was given some information on how
incident to services should be billed. Because the practice will be relying
on the information received from the Medicare Administrative
Contractor, what steps should the compliance officer take at the
conclusion of the call according to the OIG Compliance Guidance for
Individual and Small Group Physician Practices?
A. Call someone else at the Medicare Administrative Contractor to
confirm the information received.
B. Send a letter to CMS to confirm the information provided by the
Medicare Administrative Contractor is correct.
C. Both A and B
D. Document the conversation and retain the records.
●● B. Be sure any timeframes or requirements listed can be
accomplished given the practice's resources.
Answer: Developing effective compliance policies and procedures is an
important part of any compliance program. To help your practice
mitigate compliance risk, policies and procedures should:
, A. Only be one page long to promote understanding by all staff.
B. Be sure any timeframes or requirements listed can be accomplished
given the practice's resources.
C. Be written by consultants because they are more familiar with the
variety of healthcare regulations that apply to the practice.
D. Both B and C
●● C. Verify accuracy of coding and reimbursement for the services
performed.
Answer: Select the best phrase from the list below to complete the
following policy statement: Centennial Medical Associates is committed
to following Federal, State, and Local laws, rules, guidelines, and
regulations. To promote this effort, Centennial Medical Associates will
perform claims audits at least on an annual basis to
____________________.
A. Maximize reimbursement for the services performed.
B. Optimize reimbursement for the services performed.
C. Verify accuracy of coding and reimbursement for the services
performed.
D. Ensure all services are submitted for reimbursement.
●● A. Reviewing reports to see that new employees and vendors have
been checked against the OIG's list of excluded individuals and entities.
