CPCO Certification Exam 2025
Questions and Answers
C. Health Care Fraud and Abuse Control Program (HCFAC) - ....ANSWER ...-
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public
Law 104-191, what is the name of the national program designed to coordinate Federal,
State and local law enforcement activities with respect to health care fraud and abuse?
A. Health Care Fraud Prevention and Enforcement Action Team (HEAT)
B. Health Care Recovery and Affordable Care Act (HCRAC)
C. Health Care Fraud and Abuse Control Program (HCFAC)
D. Health Care Civil Penalties Law
A. Promote an organizational culture that encourages ethical conduct and a commitment
to compliance with the law. - ....ANSWER ...-According to the Federal Sentencing
Guidelines, "To have an effective compliance and ethics program..., an organization
shall exercise due diligence to prevent and detect criminal conduct." The FSGs also
state organizations shall:
A. Promote an organizational culture that encourages ethical conduct and a commitment
to compliance with the law.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 1
,B. Implement mandatory compliance programs.
C. Perform annual audits to detect criminal conduct.
D. Immediately report evidence of misconduct to the authorities.
B. Tailor those materials to the physician practice where they will be applied. -
....ANSWER ...-If a physician practice uses another entity's standards of conduct,
the practice must:
A. Implement the standards of conduct as received because they have already been
approved.
B. Tailor those materials to the physician practice where they will be applied.
C. Only select those standards that represent high risk issues for the practice.
D. None of the above. Physician practices must create their own standards of conduct. It
would be a compliance violation to copy another entity's standards of conduct.
B. For any services billed, documentation must be present in the patient's medical
record to support the services. - ....ANSWER ...-As the compliance contact for your
physician practice, you are charged with developing the policies and procedures related
to coding and billing. When developing these policies and procedures, which of the
following statements should be included?
A. If a new physician joins the practice and the new physician's NPI has not been
received, services performed should be reported using the practice medical director's
NPI.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 2
,B. For any services billed, documentation must be present in the patient's medical
record to support the services.
C. To avoid compliance risk, coding for E/M services should be based solely on medical
record documentation, even if it appears the level of service is not warranted.
D. For denied services, billing staff should notify the physician to change the reported
diagnosis to allow for resubmission and payment of the claim.
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.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 3
, 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.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 4
Questions and Answers
C. Health Care Fraud and Abuse Control Program (HCFAC) - ....ANSWER ...-
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public
Law 104-191, what is the name of the national program designed to coordinate Federal,
State and local law enforcement activities with respect to health care fraud and abuse?
A. Health Care Fraud Prevention and Enforcement Action Team (HEAT)
B. Health Care Recovery and Affordable Care Act (HCRAC)
C. Health Care Fraud and Abuse Control Program (HCFAC)
D. Health Care Civil Penalties Law
A. Promote an organizational culture that encourages ethical conduct and a commitment
to compliance with the law. - ....ANSWER ...-According to the Federal Sentencing
Guidelines, "To have an effective compliance and ethics program..., an organization
shall exercise due diligence to prevent and detect criminal conduct." The FSGs also
state organizations shall:
A. Promote an organizational culture that encourages ethical conduct and a commitment
to compliance with the law.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 1
,B. Implement mandatory compliance programs.
C. Perform annual audits to detect criminal conduct.
D. Immediately report evidence of misconduct to the authorities.
B. Tailor those materials to the physician practice where they will be applied. -
....ANSWER ...-If a physician practice uses another entity's standards of conduct,
the practice must:
A. Implement the standards of conduct as received because they have already been
approved.
B. Tailor those materials to the physician practice where they will be applied.
C. Only select those standards that represent high risk issues for the practice.
D. None of the above. Physician practices must create their own standards of conduct. It
would be a compliance violation to copy another entity's standards of conduct.
B. For any services billed, documentation must be present in the patient's medical
record to support the services. - ....ANSWER ...-As the compliance contact for your
physician practice, you are charged with developing the policies and procedures related
to coding and billing. When developing these policies and procedures, which of the
following statements should be included?
A. If a new physician joins the practice and the new physician's NPI has not been
received, services performed should be reported using the practice medical director's
NPI.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 2
,B. For any services billed, documentation must be present in the patient's medical
record to support the services.
C. To avoid compliance risk, coding for E/M services should be based solely on medical
record documentation, even if it appears the level of service is not warranted.
D. For denied services, billing staff should notify the physician to change the reported
diagnosis to allow for resubmission and payment of the claim.
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.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 3
, 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.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 4
