CPCO EXAM QUESTIONS AND
ANSWERS
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established
what comprehensive program to combat fraud committed against all health plans, both
public and private? - ANSWER-HCFAC
Response Feedback:
The Health Care Fraud and Abuse Control Program was established to combat fraud
under the joint direction of the Attorney General and the Secretary of the HHS, acting
through the department's Inspector General (HHS/OIG)
What is the most significant state program for healthcare? - ANSWER-Medicaid
Response Feedback: Medicaid and a state may have traditional fee for services or
managed care programs.
______ has mandated compliance for all providers that bill that states Medicaid. The
state has a great website that details all of the 8 elements that it requires of its
providers. - ANSWER-New York
Response Feedback:
New York has mandated compliance for all providers that bill New York Medicaid. The
state has a great website that details all of the 8 elements that it requires of providers
that bill New York Medicaid.
Which Medicare part plan contains fraud and abuse prohibitions? - ANSWER-Part E
Response Feedback:
Providers are more affected by the sections concerning Part A, Part B, Part C, Part D,
and Part E. Part A governs hospital inpatient insurance benefits (1395c to 1395i), while
Part B is supplemental insurance for outpatient services including hospital outpatient
(1395j to 1395w-20). The Medicare managed care program Medicare Advantage is Part
C. The prescription drug program is Part D. Part E contains many of the special
demonstrations and programs, as well as fraud and abuse prohibitions.
MACs are responsible for administering which of the following for Medicare Services? -
ANSWER-Payments
Response Feedback:
MACs are responsible for administrating the payment of Medicare services.
Changes in ownership must be reported within how many days to the Medicare
program? - ANSWER-30
, Response Feedback:
Ownership changes must be reported to Medicare program within 30 days.
The HCFAC program is designed to coordinate federal, state, and local law
enforcement activities with respect to healthcare _______ - ANSWER-fraud and abuse
Response Feedback:
The legislation required the establishment of a national Health Care Fraud and Abuse
Control Program (HCFAC), under the joint direction of the attorney general and the
secretary of the HHS, acting through the department's inspector general. The HCFAC
program is designed to coordinate federal, state, and local law enforcement activities
with respect to healthcare fraud and abuse.
CMS is headquartered in Baltimore and has ____regional offices around the country,
which primarily oversee enrollment and certification issues. - ANSWER-10
Response Feedback:
There are 10 regional offices around the country.
The ___________ is the entity where HIPAA is found. - ANSWER-OCR
Response Feedback:
The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy
of individually identifiable health information; the HIPAA Security Rule, which sets
national standards for the security of ePHI; the HIPAA Breach Notification Rule, which
requires covered entities and business associates to provide notification following a
breach of unsecured PHI; and the confidentiality provisions of the Patient Safety Rule,
which protect identifiable information being used to analyze patient safety events and
improve patient safety. OCR also provides oversight of the HIPAA Enforcement Rule.
Incident-to services are defined as those services that are furnished incident to
physician professional services in the physician's office (whether located in a separate
office suite or within an institution) or in a patient's home. Incident -to services are
provided by a ____________. - ANSWER-non physician provider
Response Feedback:
Incident-to services are defined as those services that are furnished incident to
physician professional services in the physician's office (whether located in a separate
office suite or within an institution) or in a patient's home. The overseeing provider does
not have to be physically present in the same room while the services are provided, but
must provide direct supervision. If it is physician's group, any physician member of the
group may be present in the office to supervise.
There have been some questions recently about whether a Non Physician Provider (NP
or PA) could see patients in the hospital or a Skilled Nursing Facility (SNF) and bill
incident-to.
ANSWERS
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established
what comprehensive program to combat fraud committed against all health plans, both
public and private? - ANSWER-HCFAC
Response Feedback:
The Health Care Fraud and Abuse Control Program was established to combat fraud
under the joint direction of the Attorney General and the Secretary of the HHS, acting
through the department's Inspector General (HHS/OIG)
What is the most significant state program for healthcare? - ANSWER-Medicaid
Response Feedback: Medicaid and a state may have traditional fee for services or
managed care programs.
______ has mandated compliance for all providers that bill that states Medicaid. The
state has a great website that details all of the 8 elements that it requires of its
providers. - ANSWER-New York
Response Feedback:
New York has mandated compliance for all providers that bill New York Medicaid. The
state has a great website that details all of the 8 elements that it requires of providers
that bill New York Medicaid.
Which Medicare part plan contains fraud and abuse prohibitions? - ANSWER-Part E
Response Feedback:
Providers are more affected by the sections concerning Part A, Part B, Part C, Part D,
and Part E. Part A governs hospital inpatient insurance benefits (1395c to 1395i), while
Part B is supplemental insurance for outpatient services including hospital outpatient
(1395j to 1395w-20). The Medicare managed care program Medicare Advantage is Part
C. The prescription drug program is Part D. Part E contains many of the special
demonstrations and programs, as well as fraud and abuse prohibitions.
MACs are responsible for administering which of the following for Medicare Services? -
ANSWER-Payments
Response Feedback:
MACs are responsible for administrating the payment of Medicare services.
Changes in ownership must be reported within how many days to the Medicare
program? - ANSWER-30
, Response Feedback:
Ownership changes must be reported to Medicare program within 30 days.
The HCFAC program is designed to coordinate federal, state, and local law
enforcement activities with respect to healthcare _______ - ANSWER-fraud and abuse
Response Feedback:
The legislation required the establishment of a national Health Care Fraud and Abuse
Control Program (HCFAC), under the joint direction of the attorney general and the
secretary of the HHS, acting through the department's inspector general. The HCFAC
program is designed to coordinate federal, state, and local law enforcement activities
with respect to healthcare fraud and abuse.
CMS is headquartered in Baltimore and has ____regional offices around the country,
which primarily oversee enrollment and certification issues. - ANSWER-10
Response Feedback:
There are 10 regional offices around the country.
The ___________ is the entity where HIPAA is found. - ANSWER-OCR
Response Feedback:
The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy
of individually identifiable health information; the HIPAA Security Rule, which sets
national standards for the security of ePHI; the HIPAA Breach Notification Rule, which
requires covered entities and business associates to provide notification following a
breach of unsecured PHI; and the confidentiality provisions of the Patient Safety Rule,
which protect identifiable information being used to analyze patient safety events and
improve patient safety. OCR also provides oversight of the HIPAA Enforcement Rule.
Incident-to services are defined as those services that are furnished incident to
physician professional services in the physician's office (whether located in a separate
office suite or within an institution) or in a patient's home. Incident -to services are
provided by a ____________. - ANSWER-non physician provider
Response Feedback:
Incident-to services are defined as those services that are furnished incident to
physician professional services in the physician's office (whether located in a separate
office suite or within an institution) or in a patient's home. The overseeing provider does
not have to be physically present in the same room while the services are provided, but
must provide direct supervision. If it is physician's group, any physician member of the
group may be present in the office to supervise.
There have been some questions recently about whether a Non Physician Provider (NP
or PA) could see patients in the hospital or a Skilled Nursing Facility (SNF) and bill
incident-to.
