CPCO chapter 3
What should be readily accessible to all coding staff?
Billing certification
CPT™ codebook
All essential coding resources
Nursing handbook - correct answer-All essential coding resources
Coders must have up-to-date resources to code correctly and send out correct claims.
What can providers review that will help them understand the compliance requirements of a
clinical lab?
Laboratory Provider Handbook
OIG's Clinical Lab Guidance
OIG Developing an Effective Compliance Program
Physician Desk Reference - correct answer-OIG's Clinical Lab Guidance
The OIG Clinical Lab Guidance provides pertinent information on effective compliance and
risk areas for laboratories.
Skilled Nursing Facilities (SNFs) are Medicare certified facilities that provide extended skilled
nursing or rehabilitative care. This care is reimbursed under which Medicare part(s)?
A
B
C
Part A and Part B - correct answer-Part A and Part B
They SNFs are typically reimbursed under Part A for the costs of most items and services,
including room, board, and ancillary items and services. However, SNFs may also receive
payment under Medicare Part B.
How many states currently require nursing facilities to perform a background check of state
records for direct-access employees?
10
35
43
50 - correct answer-43
Out of 50 states, 43 have mandated background check requirements for individuals who
have direct contact with SNF patient and/or their personal possessions.
How many states require nursing facilities to perform a FBI checks on employees?
3
5
10
27 - correct answer-10
Out of 50 states, 10 states have mandated nursing homes perform an FBI background
checks on employees.
, Which of the following should be reflected in a billing company's written policies and
procedures?
Current Federal statutes only
Current Federal and state statutes
Current regional and Federal statutes
Current state statutes only - correct answer-Current Federal and state statutes
With respect to claims, a billing company's written policies and procedures should reflect and
reinforce current federal and state statutes.
What third party plays a critical role in accurate billing and reimbursement?
Billing agencies
Laboratories
Nursing facilities
Office of Inspector General (OIG) - correct answer-Billing agencies
Providers have come to rely on billing agencies over the years to send out correct claims on
their behalf.
What should not be ignored and may require necessary policy measures to prevent
avoidable recurrence?
Compliance program
Control measures
Risk areas
Work flow - correct answer-Risk areas
Monitoring risk areas will indicate vulnerable areas for fraud and abuse that need
addressing. Compliance officers can use the results to develop any necessary policies and
procedures.
What law(s) does not require that nursing facilities conduct state or Federal FBI Bureau of
Investigation criminal background checks?
False Claims law
Federal law
Federal and state laws
State law - correct answer-Federal law
Federal law does not require that nursing facilities conduct state or Federal Bureau of
Investigation FBI criminal background checks. State laws may, however. It is important to
confirm both sources for applicable laws.
Why should compliance officers have set disciplinary policies for non-compliance?
Employees need rules to follow.
Employees should know the consequences for non-compliance of set policies.
Employees should know what is expected of them.
Employees need to understand policies set in place. - correct answer-Employees should
know the consequences for non-compliance of set policies.
There should be clear communication of what is expected of employees and equally clear
communication of the consequences for not following written policies.
What should be readily accessible to all coding staff?
Billing certification
CPT™ codebook
All essential coding resources
Nursing handbook - correct answer-All essential coding resources
Coders must have up-to-date resources to code correctly and send out correct claims.
What can providers review that will help them understand the compliance requirements of a
clinical lab?
Laboratory Provider Handbook
OIG's Clinical Lab Guidance
OIG Developing an Effective Compliance Program
Physician Desk Reference - correct answer-OIG's Clinical Lab Guidance
The OIG Clinical Lab Guidance provides pertinent information on effective compliance and
risk areas for laboratories.
Skilled Nursing Facilities (SNFs) are Medicare certified facilities that provide extended skilled
nursing or rehabilitative care. This care is reimbursed under which Medicare part(s)?
A
B
C
Part A and Part B - correct answer-Part A and Part B
They SNFs are typically reimbursed under Part A for the costs of most items and services,
including room, board, and ancillary items and services. However, SNFs may also receive
payment under Medicare Part B.
How many states currently require nursing facilities to perform a background check of state
records for direct-access employees?
10
35
43
50 - correct answer-43
Out of 50 states, 43 have mandated background check requirements for individuals who
have direct contact with SNF patient and/or their personal possessions.
How many states require nursing facilities to perform a FBI checks on employees?
3
5
10
27 - correct answer-10
Out of 50 states, 10 states have mandated nursing homes perform an FBI background
checks on employees.
, Which of the following should be reflected in a billing company's written policies and
procedures?
Current Federal statutes only
Current Federal and state statutes
Current regional and Federal statutes
Current state statutes only - correct answer-Current Federal and state statutes
With respect to claims, a billing company's written policies and procedures should reflect and
reinforce current federal and state statutes.
What third party plays a critical role in accurate billing and reimbursement?
Billing agencies
Laboratories
Nursing facilities
Office of Inspector General (OIG) - correct answer-Billing agencies
Providers have come to rely on billing agencies over the years to send out correct claims on
their behalf.
What should not be ignored and may require necessary policy measures to prevent
avoidable recurrence?
Compliance program
Control measures
Risk areas
Work flow - correct answer-Risk areas
Monitoring risk areas will indicate vulnerable areas for fraud and abuse that need
addressing. Compliance officers can use the results to develop any necessary policies and
procedures.
What law(s) does not require that nursing facilities conduct state or Federal FBI Bureau of
Investigation criminal background checks?
False Claims law
Federal law
Federal and state laws
State law - correct answer-Federal law
Federal law does not require that nursing facilities conduct state or Federal Bureau of
Investigation FBI criminal background checks. State laws may, however. It is important to
confirm both sources for applicable laws.
Why should compliance officers have set disciplinary policies for non-compliance?
Employees need rules to follow.
Employees should know the consequences for non-compliance of set policies.
Employees should know what is expected of them.
Employees need to understand policies set in place. - correct answer-Employees should
know the consequences for non-compliance of set policies.
There should be clear communication of what is expected of employees and equally clear
communication of the consequences for not following written policies.
