CPCO FINAL PAPER EXAM QUESTIONS ACCURATE ANSWERS FULL SOLUTION
Question:
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.
Question:
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.
Question:
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.
Question:
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.
Question:
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
Question:
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.
Question:
A. Reviewing reports to see that new employees and vendors have been checked against the OIG's
list of excluded individuals and entities.
Answer:
You have just been identified as the compliance officer at your practice. The OIG Compliance
Guidance for Individual and Small Group Physician Practices suggests six specific duties that may
be assigned to you. What is one of those duties? A. Reviewing reports to see that new employees
and vendors have been checked against the OIG's list of excluded individuals and entities. B.
Making sure no one changes the compliance program so you are able to show how the program was
implemented. C. Reviewing all claims being submitted to be sure they do not violate fraud and
abuse laws. D. Submitting annual reports to the Office of Inspector General on all compliance
activities undertaken during the year.
Question:
D. Regularly.
Answer:
For larger physician practices, how frequently does the OIG recommend reporting compliance
activities to the Board of Directors and CEO? A. Monthly B. Quarterly C. Annually D. Regularly
Question:
C. All employees will receive training on how to perform their jobs in compliance with the
standards of the practice and any applicable regulations.
Answer:
Question:
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.
Question:
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.
Question:
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.
Question:
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.
Question:
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
Question:
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.
Question:
A. Reviewing reports to see that new employees and vendors have been checked against the OIG's
list of excluded individuals and entities.
Answer:
You have just been identified as the compliance officer at your practice. The OIG Compliance
Guidance for Individual and Small Group Physician Practices suggests six specific duties that may
be assigned to you. What is one of those duties? A. Reviewing reports to see that new employees
and vendors have been checked against the OIG's list of excluded individuals and entities. B.
Making sure no one changes the compliance program so you are able to show how the program was
implemented. C. Reviewing all claims being submitted to be sure they do not violate fraud and
abuse laws. D. Submitting annual reports to the Office of Inspector General on all compliance
activities undertaken during the year.
Question:
D. Regularly.
Answer:
For larger physician practices, how frequently does the OIG recommend reporting compliance
activities to the Board of Directors and CEO? A. Monthly B. Quarterly C. Annually D. Regularly
Question:
C. All employees will receive training on how to perform their jobs in compliance with the
standards of the practice and any applicable regulations.
Answer:
