CPCO Certification Exam
Terms in this set (76)
Under the Health Insurance C. Health Care Fraud and Abuse Control Program
Portability and (HCFAC)
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
,According to the Federal A. Promote an organizational culture that encourages
Sentencing Guidelines, "To ethical conduct and a commitment to compliance with
have an effective the law.
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.
,If a physician practice uses B. Tailor those materials to the physician practice where
another entity's standards they will be applied.
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.
, As the compliance contact B. For any services billed, documentation must be
for your physician practice, present in the patient's medical record to support the
you are charged with services.
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.
Terms in this set (76)
Under the Health Insurance C. Health Care Fraud and Abuse Control Program
Portability and (HCFAC)
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
,According to the Federal A. Promote an organizational culture that encourages
Sentencing Guidelines, "To ethical conduct and a commitment to compliance with
have an effective the law.
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.
,If a physician practice uses B. Tailor those materials to the physician practice where
another entity's standards they will be applied.
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.
, As the compliance contact B. For any services billed, documentation must be
for your physician practice, present in the patient's medical record to support the
you are charged with services.
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.
