CPCO CERTIFICATION EXAM AND PRACTICE EXAM NEWEST 2024 ACTUAL EXAM 400 QUESTIONS AND
CORRECT DETAILED 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.
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.
,CPCO CERTIFICATION EXAM AND PRACTICE EXAM NEWEST 2024 ACTUAL EXAM 400 QUESTIONS AND
CORRECT DETAILED ANSWERS
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.
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.
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:
, CPCO CERTIFICATION EXAM AND PRACTICE EXAM NEWEST 2024 ACTUAL EXAM 400 QUESTIONS AND
CORRECT DETAILED ANSWERS
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.
CORRECT DETAILED 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.
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.
,CPCO CERTIFICATION EXAM AND PRACTICE EXAM NEWEST 2024 ACTUAL EXAM 400 QUESTIONS AND
CORRECT DETAILED ANSWERS
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.
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.
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:
, CPCO CERTIFICATION EXAM AND PRACTICE EXAM NEWEST 2024 ACTUAL EXAM 400 QUESTIONS AND
CORRECT DETAILED ANSWERS
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.
