CPCO Exam: Questions With Complete Solutions
Dr. X is a very thorough provider. He always runs a full blood panel on each
patient every year for their physical, regardless of the health of the patient.
What is this an example of: Right Ans - Waste
Which government branch was created to fight waste, fraud and abuse in all
federal health care programs especially Medicare, Medicaid? Right Ans -
Office of Inspector General (OIG)
USSC is important as it related to the Federal Sentencing Guidelines and thus
related to the core elements of compliance. What does the USSC acronym
stand for? Right Ans - United States Sentencing Commission
The OIG has stated that an effective compliance plan can help create which of
the following? Right Ans - financial success, customer loyalty, community
support, and employee satisfaction
The Office of Evaluation and Inspections is part of what agency or
department? Right Ans - Office of Inspector General
Which options are key elements for an effective compliance program?I.
Conducting external auditing and monitoring.II. Implementing compliance
and practice standards.III. Designating a compliance officer or contactIV.
Outsourcing appropriate training and education.V. Responding appropriately
to detected offenses and developing and implementing corrective action.VI.
Developing open lines of communication.VII. Enforcing disciplinary standards
through well-publicized guidelines. Right Ans - II, III, V-VII
Which statement is correct when a provider is excluded from participation
with Medicare, Medicaid, and other federal healthcare programs? Right
Ans - The provider cannot work with, and is prohibited from participation in,
all programs that deal with federal dollars.
Which office performs independent audits of HHS programs and/or HHS
grantees and contractors to examine their performance? Right Ans - Office
of Audit Services
,Kim of ABC Provider Group wants to put in a process that determines if the
compliance program is effective. What is this often called? Right Ans -
Enforcement
What does the term "anonymous reporting" refer to? Right Ans - Calling
the hotline to report an alleged violation.
Why should hotline allegations be tracked? Right Ans - To establish
patterns or trends of non-compliance
Who is responsible for developing, coordinating and conducting the necessary
training programs for all members of the healthcare organization, including
coding and billing education? Right Ans - The Compliance Officer
ABC Medical office does not have professional coders on staff but has hired
Amy to provide coding and billing compliance training for the staff. According
to the OIG compliance guidance, when professional coding staff is not
employed, who should be trained? Right Ans - Any individual directly
involved with billing and coding.
What is it considered when an employee, provider, or anyone that deals with
Federal or State healthcare dollars, has intent to receive payment for services
not legitimately rendered? Right Ans - fraud
Kelly reported Dr. X to the Compliance Officer for inappropriately billing
higher levels of E/M services than performed. Matthew, the supervisor at the
same practice is providing bonuses for members of his staff. Because Kelly
had cost the company money in auditing Dr. X, she was not given a bonus. Is
this a compliance risk and why? Right Ans - Yes; this is considered
retaliation for reporting compliance issues.
Tim at XYZ wants to conduct a baseline audit. What will the baseline audit
help determine? Right Ans - Areas of the billing department that might or
might not comply.
A Medicare beneficiary does not like the appearance of the mole on her face.
As a result, the provider removes the mole to improve the appearance. Should
this be billed to Medicare? Right Ans - Only if a denial is provided by
, Medicare and the bill is then sent to a secondary insurance carrier that will
cover the service.
What can result in imprisonment and penalties for providers and covered
entities? Right Ans - Medical fraud
When it is the intention of an organization to provide a safe environment to
patients, what should the organization design? Right Ans - Compliance
policy
Laura is the compliance officer for Angel Nursing home. She is training the
staff on tracking patient outcomes. Why it is important for nursing facilities to
track patient outcomes? Right Ans - To accomplish compliance
What action will show that a third party has good faith toward remediation?
Right Ans - Having a compliance program in place
Steve, at Orange Laboratories, wants to make sure that the lab stays in
compliance with OIG guidelines. Which of the following is required for Steve
to verify compliance? Right Ans - Ensure that there is a completed ABN
Jackie is a coder and biller for ABC Provider Group. She often puts modifiers
on various CPT® codes so that they can get paid, regardless of the
documentation. What is this an example of? Right Ans - Misuse of modifiers
What third party is in a unique position to discover fraud? Right Ans -
Medical billing companies
Which regulation, identified in the OPPS final rule, requires hospitals to
include all OPPS services provided at the same hospital to the same patient, on
the same day, on the same claim, unless certain conditions are met? Right
Ans - Same-day rule
The OIG's publication of five special fraud alerts addresses joint venture
relationships. Which of the following is considered problematic by the OIG?
Right Ans - a.Investors are chosen because they are in a position to make
referrals.b.The joint venture includes a shell laboratory.c.Investors are
required to divest their ownership interest if they cease to practice in the
service area.d.All of the above.
Dr. X is a very thorough provider. He always runs a full blood panel on each
patient every year for their physical, regardless of the health of the patient.
What is this an example of: Right Ans - Waste
Which government branch was created to fight waste, fraud and abuse in all
federal health care programs especially Medicare, Medicaid? Right Ans -
Office of Inspector General (OIG)
USSC is important as it related to the Federal Sentencing Guidelines and thus
related to the core elements of compliance. What does the USSC acronym
stand for? Right Ans - United States Sentencing Commission
The OIG has stated that an effective compliance plan can help create which of
the following? Right Ans - financial success, customer loyalty, community
support, and employee satisfaction
The Office of Evaluation and Inspections is part of what agency or
department? Right Ans - Office of Inspector General
Which options are key elements for an effective compliance program?I.
Conducting external auditing and monitoring.II. Implementing compliance
and practice standards.III. Designating a compliance officer or contactIV.
Outsourcing appropriate training and education.V. Responding appropriately
to detected offenses and developing and implementing corrective action.VI.
Developing open lines of communication.VII. Enforcing disciplinary standards
through well-publicized guidelines. Right Ans - II, III, V-VII
Which statement is correct when a provider is excluded from participation
with Medicare, Medicaid, and other federal healthcare programs? Right
Ans - The provider cannot work with, and is prohibited from participation in,
all programs that deal with federal dollars.
Which office performs independent audits of HHS programs and/or HHS
grantees and contractors to examine their performance? Right Ans - Office
of Audit Services
,Kim of ABC Provider Group wants to put in a process that determines if the
compliance program is effective. What is this often called? Right Ans -
Enforcement
What does the term "anonymous reporting" refer to? Right Ans - Calling
the hotline to report an alleged violation.
Why should hotline allegations be tracked? Right Ans - To establish
patterns or trends of non-compliance
Who is responsible for developing, coordinating and conducting the necessary
training programs for all members of the healthcare organization, including
coding and billing education? Right Ans - The Compliance Officer
ABC Medical office does not have professional coders on staff but has hired
Amy to provide coding and billing compliance training for the staff. According
to the OIG compliance guidance, when professional coding staff is not
employed, who should be trained? Right Ans - Any individual directly
involved with billing and coding.
What is it considered when an employee, provider, or anyone that deals with
Federal or State healthcare dollars, has intent to receive payment for services
not legitimately rendered? Right Ans - fraud
Kelly reported Dr. X to the Compliance Officer for inappropriately billing
higher levels of E/M services than performed. Matthew, the supervisor at the
same practice is providing bonuses for members of his staff. Because Kelly
had cost the company money in auditing Dr. X, she was not given a bonus. Is
this a compliance risk and why? Right Ans - Yes; this is considered
retaliation for reporting compliance issues.
Tim at XYZ wants to conduct a baseline audit. What will the baseline audit
help determine? Right Ans - Areas of the billing department that might or
might not comply.
A Medicare beneficiary does not like the appearance of the mole on her face.
As a result, the provider removes the mole to improve the appearance. Should
this be billed to Medicare? Right Ans - Only if a denial is provided by
, Medicare and the bill is then sent to a secondary insurance carrier that will
cover the service.
What can result in imprisonment and penalties for providers and covered
entities? Right Ans - Medical fraud
When it is the intention of an organization to provide a safe environment to
patients, what should the organization design? Right Ans - Compliance
policy
Laura is the compliance officer for Angel Nursing home. She is training the
staff on tracking patient outcomes. Why it is important for nursing facilities to
track patient outcomes? Right Ans - To accomplish compliance
What action will show that a third party has good faith toward remediation?
Right Ans - Having a compliance program in place
Steve, at Orange Laboratories, wants to make sure that the lab stays in
compliance with OIG guidelines. Which of the following is required for Steve
to verify compliance? Right Ans - Ensure that there is a completed ABN
Jackie is a coder and biller for ABC Provider Group. She often puts modifiers
on various CPT® codes so that they can get paid, regardless of the
documentation. What is this an example of? Right Ans - Misuse of modifiers
What third party is in a unique position to discover fraud? Right Ans -
Medical billing companies
Which regulation, identified in the OPPS final rule, requires hospitals to
include all OPPS services provided at the same hospital to the same patient, on
the same day, on the same claim, unless certain conditions are met? Right
Ans - Same-day rule
The OIG's publication of five special fraud alerts addresses joint venture
relationships. Which of the following is considered problematic by the OIG?
Right Ans - a.Investors are chosen because they are in a position to make
referrals.b.The joint venture includes a shell laboratory.c.Investors are
required to divest their ownership interest if they cease to practice in the
service area.d.All of the above.
