CPCO Certification Exam Questions With
Correct Answers
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 |- |CORRECT |ANSWER✔✔-C. |Health |Care |Fraud |and |Abuse |
Control |Program |(HCFAC)
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. |- |CORRECT |ANSWER✔✔-A. |
Promote |an |organizational |culture |that |encourages |ethical |conduct |and |a |commitment |to |
compliance |with |the |law.
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. |- |CORRECT |
ANSWER✔✔-B. |Tailor |those |materials |to |the |physician |practice |where |they |will |be |applied.
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. |- |CORRECT |ANSWER✔✔-B. |For |
any |services |billed, |documentation |must |be |present |in |the |patient's |medical |record |to |support
|the |services.
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 |th |- |CORRECT |ANSWER✔✔-D. |Document |the |
conversation |and |retain |the |records.
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 |- |CORRECT |ANSWER✔✔-B. |Be |sure |any |timeframes |or |requirements |listed |can
|be |accomplished |given |the |practice's |resources.
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. |- |CORRECT |ANSWER✔✔-C. |Verify |
accuracy |of |coding |and |reimbursement |for |the |services |performed.
Correct Answers
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 |- |CORRECT |ANSWER✔✔-C. |Health |Care |Fraud |and |Abuse |
Control |Program |(HCFAC)
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. |- |CORRECT |ANSWER✔✔-A. |
Promote |an |organizational |culture |that |encourages |ethical |conduct |and |a |commitment |to |
compliance |with |the |law.
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. |- |CORRECT |
ANSWER✔✔-B. |Tailor |those |materials |to |the |physician |practice |where |they |will |be |applied.
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. |- |CORRECT |ANSWER✔✔-B. |For |
any |services |billed, |documentation |must |be |present |in |the |patient's |medical |record |to |support
|the |services.
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 |th |- |CORRECT |ANSWER✔✔-D. |Document |the |
conversation |and |retain |the |records.
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 |- |CORRECT |ANSWER✔✔-B. |Be |sure |any |timeframes |or |requirements |listed |can
|be |accomplished |given |the |practice's |resources.
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. |- |CORRECT |ANSWER✔✔-C. |Verify |
accuracy |of |coding |and |reimbursement |for |the |services |performed.
