CPCO: Questions With Thorough Solutions (Rated A+)
For larger physician practices, how often does the OIG suggest reporting
compliance activities to the board of directors? Right Ans - Regularly
According to the OIG, medically unnecessary services can be billed to
Medicare for what purpose? Right Ans - To receive a denial so a claim can
be submitted to a secondary payer.
Which component of the OIG has a duty of operating the OIG hotline? Right
Ans - Office of Investigations
What year did the GAO identify Medicare claims to be at high risk for fraud
and abuse which resulted in the OIG initiating an audit of HCFA (CMS)
payment system? Right Ans - 1992
Which department of the OIG is responsible for providing mission and
administrative support to the OIG? Right Ans - Office of Management and
Policy
Which component of the OIG has a duty of conducting audits, which results in
reducing waste, abuse and mismanagement? Right Ans - Office of Audit
Services
According to Inspector General Daniel Levinson, what can help reduce
enforcement on a provider from a CIA to a CCA? Right Ans - Have a robust
and effective compliance program
A majority of the OIG's resources goes to oversight of which programs?
Right Ans - Medicare and Medicaid
What year was the Patient Protection and Affordable Care Act (PPACA)
enacted? Right Ans - 2010
What does the acronym LEP stand for? Right Ans - Limited English
Proficiency
,Everyone should be educated in their role in adhering to the Compliance
Program including their duty to report_______________. Right Ans - Suspected
misconduct
Employees have ____________to report erroneous conduct, without
repercussion, so that it may be corrected immediately. Right Ans - A duty
Records associated with an inquiry will include the nature of the inquiry or
report, the investigation procedures and outcomes, and all actions taken by
the Compliance Officer and/or the organization to rectify any non-compliance
uncovered. What is an important component of the compliance officers
responsibility when managing incidents and investigations? Right Ans -
Board of Directors need to be kept apprised of ongoing investigations and
results.
The __________is when an organization offers another organization an incentive
referrals. Right Ans - Improper inducements.
The risk assessment is an essential component of the compliance officer's
responsibilities. Once risks have been identified and prioritized, the next step
in the process is to________? Right Ans - Conduct audits based on the risk
assessment findings
When conducting a risk assessment, one of the most important and key
sources of information that a compliance office should utilize is ___________.
Right Ans - Office of Inspector General's Annual Audit Plan
One of the most important elements of an effective compliance program is to
have a compliance officer or committee who is _________. Right Ans -
Empowered.
The mission statement of the healthcare organization and a statement of why
they are in business are also know as ___________? Right Ans - The code of
conduct.
The compliance officer will report directly to Right Ans - The managing
physicians and board
,How many components are required by the OIG to have an effective
Compliance Program? Right Ans - 7
What will show a third party's good faith toward remediation? Right Ans -
Compliance Program
What is the Federal agency that provides compliance program guidance to
providers and covered entities? Right Ans - Office of Inspector General
A clinical laboratory gets all of their Medicare patients to sign a blank ABN in
case Medicare does not pay for a service. This is part of the clinic's written
policy, therefore is in compliance Y/N Right Ans - No, laboratory may never
ask a patient to sign a blank ABN
Can the government take back monies from a nursing facility for failure of a
patient's care? Right Ans - Yes, there is a direct link to quality of care and
billing for services.
Clinical Laboratories should charge physicians a price for ordered tests at
____________ Right Ans - Fair Market Value
Every third party health care company should designate someone to serve as
the focal point for compliance activities. This position is called a ___________.
Right Ans - Compliance Coordinator.
What can result in imprisonment and penalties for providers and covered
entities? Right Ans - Medical fraud
Does Medicare pay for all tests ordered by Providers? Right Ans - No, they
need to determine if it's covered and medically necessary.
What two laws relate primarily to the relationships between referral sources,
such as physicians and hospitals? Right Ans - Anti-kickback and Stark
Laws.
If physician recruitment arrangements are not properly structured, it can
result in ________________ Right Ans - EMTALA violations
, Penalties under the FCA include how much Right Ans - Treble damages,
plus a penalty of $5500 to $11,000 for each false claim filed.
What should you do when you find out one of your employees has been
excluded from government programs? Right Ans - Suspend the employee,
request documentation, and investigate the matter.
Some joint ventures may violate the Medicare and Medicaid ______________.
Right Ans - Anti-kickback statute
The Office of Civil Rights (OCR) has enforcement power for violations
occurring as a result of willful neglect. OCR can now impose civil monetary
penalties of up to how much per HIPAA privacy regulations violation. Right
Ans - $50,000
Physicians sometimes own other health-related businesses, such as physical
therapy facilities, CME or home health companies, diagnostic imaging centers,
or laboratories. Because these businesses provide designated health services,
what may be triggered? Right Ans - Stark
Which law increases the severity of penalties for violations involving
organized crime? Right Ans - RICO Act
Which law provides for a civil monetary penalty (up to $15,000 per service)
and exclusion from government programs in any case where a person submits
an improper claim, which was know to have been, or should have been know
to have been, provided through a prohibited referral, and has not refunded
the payment? Right Ans - Stark
Which of these responsibilities is not one of a compliance officer? Right Ans
- Create all policies and procedures
What are key responsibilities of a compliance officer? Right Ans - Ensure
internal controls are capable of preventing and detecting significant instances
or patterns of illegal, unethical or improper conduct.
Monitor the performance of the practice's compliance program on an ongoing
basis and take steps to improve effectiveness.
For larger physician practices, how often does the OIG suggest reporting
compliance activities to the board of directors? Right Ans - Regularly
According to the OIG, medically unnecessary services can be billed to
Medicare for what purpose? Right Ans - To receive a denial so a claim can
be submitted to a secondary payer.
Which component of the OIG has a duty of operating the OIG hotline? Right
Ans - Office of Investigations
What year did the GAO identify Medicare claims to be at high risk for fraud
and abuse which resulted in the OIG initiating an audit of HCFA (CMS)
payment system? Right Ans - 1992
Which department of the OIG is responsible for providing mission and
administrative support to the OIG? Right Ans - Office of Management and
Policy
Which component of the OIG has a duty of conducting audits, which results in
reducing waste, abuse and mismanagement? Right Ans - Office of Audit
Services
According to Inspector General Daniel Levinson, what can help reduce
enforcement on a provider from a CIA to a CCA? Right Ans - Have a robust
and effective compliance program
A majority of the OIG's resources goes to oversight of which programs?
Right Ans - Medicare and Medicaid
What year was the Patient Protection and Affordable Care Act (PPACA)
enacted? Right Ans - 2010
What does the acronym LEP stand for? Right Ans - Limited English
Proficiency
,Everyone should be educated in their role in adhering to the Compliance
Program including their duty to report_______________. Right Ans - Suspected
misconduct
Employees have ____________to report erroneous conduct, without
repercussion, so that it may be corrected immediately. Right Ans - A duty
Records associated with an inquiry will include the nature of the inquiry or
report, the investigation procedures and outcomes, and all actions taken by
the Compliance Officer and/or the organization to rectify any non-compliance
uncovered. What is an important component of the compliance officers
responsibility when managing incidents and investigations? Right Ans -
Board of Directors need to be kept apprised of ongoing investigations and
results.
The __________is when an organization offers another organization an incentive
referrals. Right Ans - Improper inducements.
The risk assessment is an essential component of the compliance officer's
responsibilities. Once risks have been identified and prioritized, the next step
in the process is to________? Right Ans - Conduct audits based on the risk
assessment findings
When conducting a risk assessment, one of the most important and key
sources of information that a compliance office should utilize is ___________.
Right Ans - Office of Inspector General's Annual Audit Plan
One of the most important elements of an effective compliance program is to
have a compliance officer or committee who is _________. Right Ans -
Empowered.
The mission statement of the healthcare organization and a statement of why
they are in business are also know as ___________? Right Ans - The code of
conduct.
The compliance officer will report directly to Right Ans - The managing
physicians and board
,How many components are required by the OIG to have an effective
Compliance Program? Right Ans - 7
What will show a third party's good faith toward remediation? Right Ans -
Compliance Program
What is the Federal agency that provides compliance program guidance to
providers and covered entities? Right Ans - Office of Inspector General
A clinical laboratory gets all of their Medicare patients to sign a blank ABN in
case Medicare does not pay for a service. This is part of the clinic's written
policy, therefore is in compliance Y/N Right Ans - No, laboratory may never
ask a patient to sign a blank ABN
Can the government take back monies from a nursing facility for failure of a
patient's care? Right Ans - Yes, there is a direct link to quality of care and
billing for services.
Clinical Laboratories should charge physicians a price for ordered tests at
____________ Right Ans - Fair Market Value
Every third party health care company should designate someone to serve as
the focal point for compliance activities. This position is called a ___________.
Right Ans - Compliance Coordinator.
What can result in imprisonment and penalties for providers and covered
entities? Right Ans - Medical fraud
Does Medicare pay for all tests ordered by Providers? Right Ans - No, they
need to determine if it's covered and medically necessary.
What two laws relate primarily to the relationships between referral sources,
such as physicians and hospitals? Right Ans - Anti-kickback and Stark
Laws.
If physician recruitment arrangements are not properly structured, it can
result in ________________ Right Ans - EMTALA violations
, Penalties under the FCA include how much Right Ans - Treble damages,
plus a penalty of $5500 to $11,000 for each false claim filed.
What should you do when you find out one of your employees has been
excluded from government programs? Right Ans - Suspend the employee,
request documentation, and investigate the matter.
Some joint ventures may violate the Medicare and Medicaid ______________.
Right Ans - Anti-kickback statute
The Office of Civil Rights (OCR) has enforcement power for violations
occurring as a result of willful neglect. OCR can now impose civil monetary
penalties of up to how much per HIPAA privacy regulations violation. Right
Ans - $50,000
Physicians sometimes own other health-related businesses, such as physical
therapy facilities, CME or home health companies, diagnostic imaging centers,
or laboratories. Because these businesses provide designated health services,
what may be triggered? Right Ans - Stark
Which law increases the severity of penalties for violations involving
organized crime? Right Ans - RICO Act
Which law provides for a civil monetary penalty (up to $15,000 per service)
and exclusion from government programs in any case where a person submits
an improper claim, which was know to have been, or should have been know
to have been, provided through a prohibited referral, and has not refunded
the payment? Right Ans - Stark
Which of these responsibilities is not one of a compliance officer? Right Ans
- Create all policies and procedures
What are key responsibilities of a compliance officer? Right Ans - Ensure
internal controls are capable of preventing and detecting significant instances
or patterns of illegal, unethical or improper conduct.
Monitor the performance of the practice's compliance program on an ongoing
basis and take steps to improve effectiveness.
