CPCO Exam Questions and Verified Answers (2023/ 2024 Update)

CPCO Exam Questions and Verified Answers (2023/ 2024 Update) 1. What is the goal of ongoing auditing and monitoring in a physician's practice? ~ Answer: Ongoing auditing and monitoring will evaluate whether the physician practice's standards and procedures are current and accurate and whether the compliance program is working. 2. A compliance program's plan for communication should include a provision for non-retaliation for reporting fraudulent conduct. Which method below helps ensure that an employee would be free from retribution? ~ Answer: Well-publicized disciplinary actions for retaliation 3. What does the HHS OIG suggest as possible warning signs that non-compliance may exist? ~ Answer: Significant change in the number or type of claim rejections. 4. Having the ability to respond to issues enables a practice to develop effective action plans to correct problems and prevent future problems from occurring. What is one step that can be taken to establish compliance effectiveness for the response/prevention element? ~ Answer: Create a response team, consisting of representatives from compliance, audit, and any other relevant functional department. 5. A physician office laboratory is authorized to perform urinalysis testing, including the microscopic analysis under their PPMP certification. It has been the physician's experience that many of his patients that have urinalysis testing done also require the microscopic exam. Because of this and to be able to provide better treatment, he has established an office policy that for all urinalysis testing performed in his office, the lab should also perform the microscopic test. Is this a compliance risk? ~ Answer: Yes. Performing the microscopic test on all patients when the results of the urinalysis are negative could be considered medically unnecessary. 6. Billing companies should have written policies and procedures that reflect and reinforce Federal and State statutes. These policies must create a mechanism for the billing or reimbursement staff to communicate effectively and accurately with the health care provider. Which of the following policies and procedures should a billing office have in place to meet these needs? ~ Answer: Establish and maintain a process for pre- and post-submission review of claims to ensure claims submitted for reimbursement accurately represent services provided, are supported by sufficient documentation and are in conformity with any applicable coverage criteria for reimbursement 7. According to the OIG, medically unnecessary services should only be billed to Medicare in what circumstance? ~ Answer: To receive a denial so that the claim can be submitted to a secondary payer. 8. As part of a practice's compliance program, record retention policies and procedures should be developed. This policy and procedure should address the timeframes associated with the retention of various records. When developing a policy, which of the following statements should be present? ~ Answer: Specific records must be retained based upon the most stringent requirement identified in federal or state law, or internal policies and procedures