CPCO STUDY GUIDE EXAM QUESTIONS
WITH CORRECT ANSWERS
One |of |the |most |important |elements |of |an |effective |compliance |program |is |to |have |a |
compliance |officer |or |committee |who |is__________. |- |CORRECT |ANSWER✔✔-empowered
If |an |employee, |provider |or |anyone |that |deals |with |Federal |or |State |healthcare |dollars |has |
intent |to |receive |payment |for |services |not |legitimately |rendered |this |is |considered |
______________? |- |CORRECT |ANSWER✔✔-fraud
Joan, |as |an |employee |of |a |healthcare |organization, |has |_________to |report |erroneous |
conduct, |without |repercussions, |so |that |it |may |be |corrected |immediately |- |CORRECT |
ANSWER✔✔-duty
person |who |exposes |misconduct, |alleged |dishonest |or |illegal |activity |occurring |in |an |
organization |is |called |a______________? |- |CORRECT |ANSWER✔✔-relator
The |compliance |program |will |flounder |if |employees |of |the |organization |are |not |aware |of |
_________? |- |CORRECT |ANSWER✔✔-laws |and |regulations |that |pertain |to |their |specific |job |
descriptions
When |physicians |(or |their |staff) |make |billing |mistakes |and |errors |the |most |important |thing |to |
do |is |_________? |- |CORRECT |ANSWER✔✔-Send |a |refund
Judy |is |the |Compliance |Officer |for |Apple |Medical |Group. |The |practice |is |a |small |group |of |
providers. |Judy |wants |to |have |an |open |door |policy |as |suggested |by |the |OIG, |thus |she |will? |- |
CORRECT |ANSWER✔✔-Post |notices |of |up-to-date |compliance |information |on |the |employee |
bulletin |board
,Participants |in |the |Federal |healthcare |programs |have |an |obligation |to |take |measures, |such |as |
instituting |a |compliance |program, |to |_________________? |- |CORRECT |ANSWER✔✔-detects |
and |prevent |fraudulent, |abusive |and |wasteful |activities
Tim, |the |Compliance |Officer |for |XYZ |Community |Hospital, |should |report |to |whom? |- |CORRECT |
ANSWER✔✔-CEO |or |Board
The |biller |at |XYZ |Community |Hospital |wants |to |win |the |award |every |month |for |posting |the |
most |insurance |checks. |Instead |of |giving |the |claims |30-60 |days |to |clear, |she |bills |them |again |at
|the |end |of |the |month. |This |is |an |example |of? |- |CORRECT |ANSWER✔✔-double |billing
The |OIG |has |described |seven |basic |components |of |an |effective |compliance |program |for |a |
small |physician |practice |that |are |based |from |the |_______________? |- |CORRECT |ANSWER✔✔-
Federal |Sentencing |Guidelines
Kim, |Compliance |Officer |for |ABC |Provider |Group, |created |a |compliance |plan |and |policy |a |year |
ago. |While |reviewing |the |groups |Baseline |Audits |it |comes |to |her |attention |that |many |of |the |
staff |have |decided |NOT |to |follow |the |compliance |plan. |The |Non-Compliance |has |
____________? |- |CORRECT |ANSWER✔✔-created |a |big |risk |of |the |group |and |Kim |needs |to |
make |sure |that |everyone |knows |about |the |risk |of |not |following |the |compliance |plan
A |high-level |statement |or |plan |that |embraces |an |organization's |general |beliefs, |goals, |
objectives |and |acceptable |procedure |for |a |specified |subject |area |is |a |_______________? |- |
CORRECT |ANSWER✔✔-policy
Kim |is |the |Compliance |Officer |for |ABC |Provider |Group. |Kim |has |read |the |OIG |Compliance |
Program |Guidance |that |acknowledges |patient |care |as |the |first |priority |of |a |physician |practice. |
As |the |Compliance |Officer |(CO), |Kim |should |implement |what |type |of |compliance |model? |- |
CORRECT |ANSWER✔✔-A |"patients |first"
,It |is |important |to |educate |employees |of |the |methods |they |may |utilize |to |directly |notify |and |
communicate |issues |of |suspected |areas |of |non-compliance. |What |is |considered |a |best |practice
|method |of |anonymous |reporting? |- |CORRECT |ANSWER✔✔-intra-office |or |USPS |mail
Tim |at |XYZ |wants |to |conduct |a |baseline |audit |to |help |determine? |- |CORRECT |ANSWER✔✔-
areas |of |the |billing |department |that |might |be |in |compliance
When |the |term |Open |Door |Policy |is |used |in |reference |to |the |Effective |Communication, |what |is
|this |referring |to? |- |CORRECT |ANSWER✔✔-The |Compliance |Officer |is |accessible |to |all |
employees |via |many |methods |of |communication
When |Kim |from |ABC |Provider |Group |is |conducting |a |risk |assessment, |one |of |the |most |
important |and |key |sources |of |information |that |Kim |as |the |Compliance |Officer |should |utilize |
is_____________. |- |CORRECT |ANSWER✔✔-the |Office |of |Inspector |General's |Annual |Work |Plan
The |mission |statement |of |the |healthcare |organization |and |a |statement |of |why |they |are |in |
business |are |also |known |as |_________? |- |CORRECT |ANSWER✔✔-The |Code |of |conduct
How |often |should |the |Tim, |Compliance |Officer |for |XYZ |Community |Hospital |update |the |
compliance |program |and |plan? |- |CORRECT |ANSWER✔✔-As |laws |and |regulations |change; |and |
at |least |annually
After |an |employee |receives |their |initial |training |regarding |the |practice/organization |
Compliance |Program |what |is |the |next |step |the |compliance |officer |should |take |to |protect |the |
practice |against |potential |noncompliance |activity? |- |CORRECT |ANSWER✔✔-Perform |a |baseline
|assessment |of |the |employee's |competency |scores |to |determine |if |additional |training |is |
required
ABC |Provider |Group |and |Apple |Medical |Group |agree |to |pool |their |resources |for |the |purpose |
of |accomplishing |a |specific |task. |This |is |called |_____________. |- |CORRECT |ANSWER✔✔-Joint |
ventures
, The |following |is |not |a |level |of |non-compliance: |- |CORRECT |ANSWER✔✔-Mistake |in |billing
For |potential |criminal |violations, |a |practice |should |have |immediate |discussions |with |a |criminal |
attorney |who |- |CORRECT |ANSWER✔✔-Is |well |versed |in |Healthcare |Fraud |and |Abuse |law
The |Compliance |Officer's |main |two |responsibilities |are |to |____________the
|practice/organization's |compliance |program. |- |CORRECT |ANSWER✔✔-develops |and |then |
implement
Judy |is |the |Compliance |Officer |for |Apple |Medical |Group. |The |providers |of |the |group |ask |Judy |
to |design |a |new |Compliance |Plan. |Should |Judy |ask |some |other |practices |in |town |for |a |copy |of |
their |Compliance |Plan? |Do |all |Compliance |Programs |have |to |be |the |same |regardless |of |the |
practice |size |or |specialty? |Why? |- |CORRECT |ANSWER✔✔-No, |compliance |programs |need |to |be
|tailored |to |fit |the |unique |needs |of |every |organization |or |physician |practice
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? |- |CORRECT |
ANSWER✔✔-United |States |Sentencing |Commission
Kathy, |the |Compliance |Officer |at |a |small |provider |office, |is |notified |that |a |non-English |speaking
|patient |will |be |arriving |today. |A |LEP |person/patient |who |needs |an |interpreter |to |translate |to |
and |from |the |person's |primary |language |must |be |provided. |- |CORRECT |ANSWER✔✔-at |no |cost
|to |the |patient |or |insurance |carrier
In |addition |to |hospitals, |what |other |type |of |facility |did |the |OIG |provide |supplemental |
compliance |program |guidance |for? |- |CORRECT |ANSWER✔✔-Nursing |Facilities
What |is |(are) |considered |a |significant |element(s) |in |fraud? |- |CORRECT |ANSWER✔✔-Knowingly |
and |Intent
WITH CORRECT ANSWERS
One |of |the |most |important |elements |of |an |effective |compliance |program |is |to |have |a |
compliance |officer |or |committee |who |is__________. |- |CORRECT |ANSWER✔✔-empowered
If |an |employee, |provider |or |anyone |that |deals |with |Federal |or |State |healthcare |dollars |has |
intent |to |receive |payment |for |services |not |legitimately |rendered |this |is |considered |
______________? |- |CORRECT |ANSWER✔✔-fraud
Joan, |as |an |employee |of |a |healthcare |organization, |has |_________to |report |erroneous |
conduct, |without |repercussions, |so |that |it |may |be |corrected |immediately |- |CORRECT |
ANSWER✔✔-duty
person |who |exposes |misconduct, |alleged |dishonest |or |illegal |activity |occurring |in |an |
organization |is |called |a______________? |- |CORRECT |ANSWER✔✔-relator
The |compliance |program |will |flounder |if |employees |of |the |organization |are |not |aware |of |
_________? |- |CORRECT |ANSWER✔✔-laws |and |regulations |that |pertain |to |their |specific |job |
descriptions
When |physicians |(or |their |staff) |make |billing |mistakes |and |errors |the |most |important |thing |to |
do |is |_________? |- |CORRECT |ANSWER✔✔-Send |a |refund
Judy |is |the |Compliance |Officer |for |Apple |Medical |Group. |The |practice |is |a |small |group |of |
providers. |Judy |wants |to |have |an |open |door |policy |as |suggested |by |the |OIG, |thus |she |will? |- |
CORRECT |ANSWER✔✔-Post |notices |of |up-to-date |compliance |information |on |the |employee |
bulletin |board
,Participants |in |the |Federal |healthcare |programs |have |an |obligation |to |take |measures, |such |as |
instituting |a |compliance |program, |to |_________________? |- |CORRECT |ANSWER✔✔-detects |
and |prevent |fraudulent, |abusive |and |wasteful |activities
Tim, |the |Compliance |Officer |for |XYZ |Community |Hospital, |should |report |to |whom? |- |CORRECT |
ANSWER✔✔-CEO |or |Board
The |biller |at |XYZ |Community |Hospital |wants |to |win |the |award |every |month |for |posting |the |
most |insurance |checks. |Instead |of |giving |the |claims |30-60 |days |to |clear, |she |bills |them |again |at
|the |end |of |the |month. |This |is |an |example |of? |- |CORRECT |ANSWER✔✔-double |billing
The |OIG |has |described |seven |basic |components |of |an |effective |compliance |program |for |a |
small |physician |practice |that |are |based |from |the |_______________? |- |CORRECT |ANSWER✔✔-
Federal |Sentencing |Guidelines
Kim, |Compliance |Officer |for |ABC |Provider |Group, |created |a |compliance |plan |and |policy |a |year |
ago. |While |reviewing |the |groups |Baseline |Audits |it |comes |to |her |attention |that |many |of |the |
staff |have |decided |NOT |to |follow |the |compliance |plan. |The |Non-Compliance |has |
____________? |- |CORRECT |ANSWER✔✔-created |a |big |risk |of |the |group |and |Kim |needs |to |
make |sure |that |everyone |knows |about |the |risk |of |not |following |the |compliance |plan
A |high-level |statement |or |plan |that |embraces |an |organization's |general |beliefs, |goals, |
objectives |and |acceptable |procedure |for |a |specified |subject |area |is |a |_______________? |- |
CORRECT |ANSWER✔✔-policy
Kim |is |the |Compliance |Officer |for |ABC |Provider |Group. |Kim |has |read |the |OIG |Compliance |
Program |Guidance |that |acknowledges |patient |care |as |the |first |priority |of |a |physician |practice. |
As |the |Compliance |Officer |(CO), |Kim |should |implement |what |type |of |compliance |model? |- |
CORRECT |ANSWER✔✔-A |"patients |first"
,It |is |important |to |educate |employees |of |the |methods |they |may |utilize |to |directly |notify |and |
communicate |issues |of |suspected |areas |of |non-compliance. |What |is |considered |a |best |practice
|method |of |anonymous |reporting? |- |CORRECT |ANSWER✔✔-intra-office |or |USPS |mail
Tim |at |XYZ |wants |to |conduct |a |baseline |audit |to |help |determine? |- |CORRECT |ANSWER✔✔-
areas |of |the |billing |department |that |might |be |in |compliance
When |the |term |Open |Door |Policy |is |used |in |reference |to |the |Effective |Communication, |what |is
|this |referring |to? |- |CORRECT |ANSWER✔✔-The |Compliance |Officer |is |accessible |to |all |
employees |via |many |methods |of |communication
When |Kim |from |ABC |Provider |Group |is |conducting |a |risk |assessment, |one |of |the |most |
important |and |key |sources |of |information |that |Kim |as |the |Compliance |Officer |should |utilize |
is_____________. |- |CORRECT |ANSWER✔✔-the |Office |of |Inspector |General's |Annual |Work |Plan
The |mission |statement |of |the |healthcare |organization |and |a |statement |of |why |they |are |in |
business |are |also |known |as |_________? |- |CORRECT |ANSWER✔✔-The |Code |of |conduct
How |often |should |the |Tim, |Compliance |Officer |for |XYZ |Community |Hospital |update |the |
compliance |program |and |plan? |- |CORRECT |ANSWER✔✔-As |laws |and |regulations |change; |and |
at |least |annually
After |an |employee |receives |their |initial |training |regarding |the |practice/organization |
Compliance |Program |what |is |the |next |step |the |compliance |officer |should |take |to |protect |the |
practice |against |potential |noncompliance |activity? |- |CORRECT |ANSWER✔✔-Perform |a |baseline
|assessment |of |the |employee's |competency |scores |to |determine |if |additional |training |is |
required
ABC |Provider |Group |and |Apple |Medical |Group |agree |to |pool |their |resources |for |the |purpose |
of |accomplishing |a |specific |task. |This |is |called |_____________. |- |CORRECT |ANSWER✔✔-Joint |
ventures
, The |following |is |not |a |level |of |non-compliance: |- |CORRECT |ANSWER✔✔-Mistake |in |billing
For |potential |criminal |violations, |a |practice |should |have |immediate |discussions |with |a |criminal |
attorney |who |- |CORRECT |ANSWER✔✔-Is |well |versed |in |Healthcare |Fraud |and |Abuse |law
The |Compliance |Officer's |main |two |responsibilities |are |to |____________the
|practice/organization's |compliance |program. |- |CORRECT |ANSWER✔✔-develops |and |then |
implement
Judy |is |the |Compliance |Officer |for |Apple |Medical |Group. |The |providers |of |the |group |ask |Judy |
to |design |a |new |Compliance |Plan. |Should |Judy |ask |some |other |practices |in |town |for |a |copy |of |
their |Compliance |Plan? |Do |all |Compliance |Programs |have |to |be |the |same |regardless |of |the |
practice |size |or |specialty? |Why? |- |CORRECT |ANSWER✔✔-No, |compliance |programs |need |to |be
|tailored |to |fit |the |unique |needs |of |every |organization |or |physician |practice
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? |- |CORRECT |
ANSWER✔✔-United |States |Sentencing |Commission
Kathy, |the |Compliance |Officer |at |a |small |provider |office, |is |notified |that |a |non-English |speaking
|patient |will |be |arriving |today. |A |LEP |person/patient |who |needs |an |interpreter |to |translate |to |
and |from |the |person's |primary |language |must |be |provided. |- |CORRECT |ANSWER✔✔-at |no |cost
|to |the |patient |or |insurance |carrier
In |addition |to |hospitals, |what |other |type |of |facility |did |the |OIG |provide |supplemental |
compliance |program |guidance |for? |- |CORRECT |ANSWER✔✔-Nursing |Facilities
What |is |(are) |considered |a |significant |element(s) |in |fraud? |- |CORRECT |ANSWER✔✔-Knowingly |
and |Intent
