CPCO Exam Prep: Questions With Detailed Solutions
The Federal Sentencing Guidelines (FSGs) are rules that set out a uniform
sentencing policy for those convicted of felonies and serious (Class A)
misdemeanors in the United States' federal courts system. In healthcare, the
FSGs are used as the core elements for which of the following?
I. The OIG's Five-Principle Strategy to combat healthcare fraud, waste, and
abuse.
II. The seven core elements of an effective compliance program.
III. The core elements of corporate integrity agreements.
IV. The final rule for the Medicare Access and CHIP Reauthorization Act
(MACRA).
V. The False Claims Act (FCA). Right Ans - II and III
The compliance program guidance is recognized by the United States
Sentencing Commission (USSC). These seven core elements are used by the
USSC as the basis for FSGs for healthcare offenses. The core elements of CIAs
were created in the 1995 Federal Sentencing Guidelines.
Which office is responsible for enforcing the HIPAA Privacy Rule and Security
Rule provisions?
Office of Civil Rights (OCR)
Department of Justice (DOJ)
Department of Labor (DOL)
Office of Inspector General (OIG) Right Ans - Office of Civil Rights (OCR)
Which office performs independent audits of HHS programs and/or HHS
grantees and contractors to examine their performance?
Immediate Office of Inspector General
Office of Audit Services
Office of Evaluations and Inspections
Office of Management and Policy Right Ans - Office of Audit Services
,According to Inspector General Daniel Levinson, what can help reduce
enforcement on a provider from a corporate integrity agreement (CIA) to a
certification of compliance agreement (CCA)?
The provider demonstrates a compliance plan has been distributed to all
employees.
The provider has a robust and effective compliance program.
The provider has a compliance officer on staff.
The provider keeps a copy of all coding rules which support their coding.
Right Ans - The provider has a robust and effective compliance program.
Compliance certification agreements (CCAs) require providers to certify they
will continue to operate their existing compliance program for a fixed term.
During this term, is an independent review organization (IRO) required?
No, an IRO is not required for a CCA.
Yes, an IRO is required for all CCA agreements.
It depends; an IRO is only required for certain entities that have signed a CCA.
Yes, IROs are required for both CIA and CCA arrangements. Right Ans - No,
an IRO is not required for a CCA.
The OIG has stated that an effective compliance plan can help create which of
the following?
Customer loyalty, a need for refunds, and overpayments from insurance
carriers.
Community support, financial success, wealthy physicians.
Financial success, flawless billing, and lessen staff required to support the
practice.
,Customer loyalty, community support, and financial success. Right Ans -
Customer loyalty, community support, and financial success.
Jill is the compliance officer for Dr. X. Jill wants to send all lab referrals to the
lab that her physician owns. Is this considered fraud?
No, it is considered waste.
Yes, it is considered fraud.
No, it is considered abuse.
Yes, only because lab services owned by providers is a special category so
therefore it is fraud. Right Ans - Yes, it is considered fraud.
What is a high-level statement or plan that embraces an organization's
general beliefs, goals, objectives and acceptable procedure for a specified
subject area?
a. policy
b. standard for all organizations
c. risk for the organization
d. compliance program Right Ans - policy
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 non-
compliance activity?
a. Retain the training record for employee evaluation reviews.
b. Perform a baseline assessment of the employee's competency scores to
determine if additional training is required.
c. repeat the training in 1 year.
, d. No additional steps are necessary; the requirement to train new employees
has been met. Right Ans - Perform a baseline assessment of the employee's
competency scores to determine if additional training is required.
The first responsibility of the Compliance Officer is the development of the
Compliance Program. What is the first step in the process that needs to be
completed before the formal Compliance Program documents are drafted?
a. Training and education should be conducted.
b. Conduct a HIPAA and OSHA audit.
c. Areas of risk need to be assessed.
d. Policies and procedures should be developed. Right Ans - Areas of risk
need to be assessed.
What is more important to have in place for enforcing and disciplining
individuals who violate the practice's compliance program or other practice
standards?
a. Training
b. Rules
c. Procedures
d. Meetings Right Ans - Procedures
Kim, the Compliance Officer for ABC Provider Group, created a compliance
plan and policy one 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. Which statement is TRUE regarding this scenario?
a. No issues of no-compliance have exist in the scenario.
b. The non-compliance has created issues that will cause huge fines for the
practice
The Federal Sentencing Guidelines (FSGs) are rules that set out a uniform
sentencing policy for those convicted of felonies and serious (Class A)
misdemeanors in the United States' federal courts system. In healthcare, the
FSGs are used as the core elements for which of the following?
I. The OIG's Five-Principle Strategy to combat healthcare fraud, waste, and
abuse.
II. The seven core elements of an effective compliance program.
III. The core elements of corporate integrity agreements.
IV. The final rule for the Medicare Access and CHIP Reauthorization Act
(MACRA).
V. The False Claims Act (FCA). Right Ans - II and III
The compliance program guidance is recognized by the United States
Sentencing Commission (USSC). These seven core elements are used by the
USSC as the basis for FSGs for healthcare offenses. The core elements of CIAs
were created in the 1995 Federal Sentencing Guidelines.
Which office is responsible for enforcing the HIPAA Privacy Rule and Security
Rule provisions?
Office of Civil Rights (OCR)
Department of Justice (DOJ)
Department of Labor (DOL)
Office of Inspector General (OIG) Right Ans - Office of Civil Rights (OCR)
Which office performs independent audits of HHS programs and/or HHS
grantees and contractors to examine their performance?
Immediate Office of Inspector General
Office of Audit Services
Office of Evaluations and Inspections
Office of Management and Policy Right Ans - Office of Audit Services
,According to Inspector General Daniel Levinson, what can help reduce
enforcement on a provider from a corporate integrity agreement (CIA) to a
certification of compliance agreement (CCA)?
The provider demonstrates a compliance plan has been distributed to all
employees.
The provider has a robust and effective compliance program.
The provider has a compliance officer on staff.
The provider keeps a copy of all coding rules which support their coding.
Right Ans - The provider has a robust and effective compliance program.
Compliance certification agreements (CCAs) require providers to certify they
will continue to operate their existing compliance program for a fixed term.
During this term, is an independent review organization (IRO) required?
No, an IRO is not required for a CCA.
Yes, an IRO is required for all CCA agreements.
It depends; an IRO is only required for certain entities that have signed a CCA.
Yes, IROs are required for both CIA and CCA arrangements. Right Ans - No,
an IRO is not required for a CCA.
The OIG has stated that an effective compliance plan can help create which of
the following?
Customer loyalty, a need for refunds, and overpayments from insurance
carriers.
Community support, financial success, wealthy physicians.
Financial success, flawless billing, and lessen staff required to support the
practice.
,Customer loyalty, community support, and financial success. Right Ans -
Customer loyalty, community support, and financial success.
Jill is the compliance officer for Dr. X. Jill wants to send all lab referrals to the
lab that her physician owns. Is this considered fraud?
No, it is considered waste.
Yes, it is considered fraud.
No, it is considered abuse.
Yes, only because lab services owned by providers is a special category so
therefore it is fraud. Right Ans - Yes, it is considered fraud.
What is a high-level statement or plan that embraces an organization's
general beliefs, goals, objectives and acceptable procedure for a specified
subject area?
a. policy
b. standard for all organizations
c. risk for the organization
d. compliance program Right Ans - policy
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 non-
compliance activity?
a. Retain the training record for employee evaluation reviews.
b. Perform a baseline assessment of the employee's competency scores to
determine if additional training is required.
c. repeat the training in 1 year.
, d. No additional steps are necessary; the requirement to train new employees
has been met. Right Ans - Perform a baseline assessment of the employee's
competency scores to determine if additional training is required.
The first responsibility of the Compliance Officer is the development of the
Compliance Program. What is the first step in the process that needs to be
completed before the formal Compliance Program documents are drafted?
a. Training and education should be conducted.
b. Conduct a HIPAA and OSHA audit.
c. Areas of risk need to be assessed.
d. Policies and procedures should be developed. Right Ans - Areas of risk
need to be assessed.
What is more important to have in place for enforcing and disciplining
individuals who violate the practice's compliance program or other practice
standards?
a. Training
b. Rules
c. Procedures
d. Meetings Right Ans - Procedures
Kim, the Compliance Officer for ABC Provider Group, created a compliance
plan and policy one 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. Which statement is TRUE regarding this scenario?
a. No issues of no-compliance have exist in the scenario.
b. The non-compliance has created issues that will cause huge fines for the
practice
