CPCO CERTIFICATION EXAM
QUESTIONS AND ANSWERS
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. - 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.
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
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-When
conducting compliance training within a physician practice, what is one of the goals that
the practice should strive for in this training?
A. Only new employees will receive training on how to perform their jobs in compliance
with the standards of the practice and any applicable regulations.
B. Managers of employees will receive training on how to perform their jobs in
compliance with the standards of the practice and any applicable regulations.
C. All employees will receive training on how to perform their jobs in compliance with
the standards of the practice and any applicable regulations.
D. All employees will receive training on the definition of compliance.
C. 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. - ANSWER-What is the goal of ongoing auditing and monitoring in
a physician's practice?
A. Ongoing auditing and monitoring will prevent fraud
B. Ongoing auditing and monitoring will enhance revenues by detecting instances of
undercoding.
, C. 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.
D. Ongoing auditing and monitoring will improve the quality of patient care.
C. Well-publicized disciplinary actions for retaliation - ANSWER-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?
A. A clearly defined chain of command for reporting potentially fraudulent conduct
B. Guaranteed anonymity
C. Well-publicized disciplinary actions for retaliation
D. A policy that encourages reporting directly to the OIG
A. Significant change in the number or type of claim rejections. - ANSWER-What does
the HHS OIG suggest as possible warning signs that non-compliance may exist?
A. Significant change in the number or type of claim rejections.
B. Getting carrier newsletters pertaining to the types of service that your practice bills.
C. Consistent use of certain codes.
D. Receipt of carrier requests for documentation.
B. Create a response team, consisting of representatives from compliance, audit, and
any other relevant functional department. - ANSWER-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 responding to and/or preventing compliance issues?
A. Create a response team, consisting of representatives from the compliance and audit
department.
B. Create a response team, consisting of representatives from compliance, audit, and
any other relevant functional department.
C. Create an investigation team, consisting of representatives from compliance, audit,
and any other relevant functional department.
D. Create a prevention team, consisting of representatives from compliance, audit, and
any other relevant functional department.
A. Yes. Performing the microscopic test on all patients when the results of the urinalysis
are negative could be considered medically unnecessary. - ANSWER-A physician office
laboratory is authorized to perform urinalysis testing, including the microscopic analysis
under their Provider-Performed Microscopy Procedures (PPMP) certification. It has
been the physician's experience that many of his patients that have urinalysis testing
done also requires 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
QUESTIONS AND ANSWERS
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. - 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.
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
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-When
conducting compliance training within a physician practice, what is one of the goals that
the practice should strive for in this training?
A. Only new employees will receive training on how to perform their jobs in compliance
with the standards of the practice and any applicable regulations.
B. Managers of employees will receive training on how to perform their jobs in
compliance with the standards of the practice and any applicable regulations.
C. All employees will receive training on how to perform their jobs in compliance with
the standards of the practice and any applicable regulations.
D. All employees will receive training on the definition of compliance.
C. 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. - ANSWER-What is the goal of ongoing auditing and monitoring in
a physician's practice?
A. Ongoing auditing and monitoring will prevent fraud
B. Ongoing auditing and monitoring will enhance revenues by detecting instances of
undercoding.
, C. 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.
D. Ongoing auditing and monitoring will improve the quality of patient care.
C. Well-publicized disciplinary actions for retaliation - ANSWER-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?
A. A clearly defined chain of command for reporting potentially fraudulent conduct
B. Guaranteed anonymity
C. Well-publicized disciplinary actions for retaliation
D. A policy that encourages reporting directly to the OIG
A. Significant change in the number or type of claim rejections. - ANSWER-What does
the HHS OIG suggest as possible warning signs that non-compliance may exist?
A. Significant change in the number or type of claim rejections.
B. Getting carrier newsletters pertaining to the types of service that your practice bills.
C. Consistent use of certain codes.
D. Receipt of carrier requests for documentation.
B. Create a response team, consisting of representatives from compliance, audit, and
any other relevant functional department. - ANSWER-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 responding to and/or preventing compliance issues?
A. Create a response team, consisting of representatives from the compliance and audit
department.
B. Create a response team, consisting of representatives from compliance, audit, and
any other relevant functional department.
C. Create an investigation team, consisting of representatives from compliance, audit,
and any other relevant functional department.
D. Create a prevention team, consisting of representatives from compliance, audit, and
any other relevant functional department.
A. Yes. Performing the microscopic test on all patients when the results of the urinalysis
are negative could be considered medically unnecessary. - ANSWER-A physician office
laboratory is authorized to perform urinalysis testing, including the microscopic analysis
under their Provider-Performed Microscopy Procedures (PPMP) certification. It has
been the physician's experience that many of his patients that have urinalysis testing
done also requires 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
