CPCO CERTIFICATION EXAM NEWEST
ACTUAL EXAM QUESTIONS AND
DETAILED CORRECT ANSWERS 2024-
2025 | ALREADY PASSED
A compliance program's plan for communication should
include a provision for non-retaliation for reporting
fraudulent conduct. Which method below helps ensure
that an employee would be free from retribution?
A. A clearly defined chain of command for reporting
potentially fraudulent conduct
B. Guaranteed anonymity
C. Well-publicized disciplinary actions for retaliation
D. A policy that encourages reporting directly to the OIG
Correct Answer C. Well-publicized disciplinary actions for
retaliation
What does the HHS OIG suggest as possible warning
signs that non-compliance may exist?
A. Significant change in the number or type of claim
rejections.
B. Getting carrier newsletters pertaining to the types of
service that your practice bills.
C. Consistent use of certain codes.
D. Receipt of carrier requests for documentation. Correct
Answer A. Significant change in the number or type of
claim rejections.
,Having the ability to respond to issues enables a practice
to develop effective action plans to correct problems and
prevent future problems from occurring. What is one step
that can be taken to establish compliance effectiveness for
responding to and/or preventing compliance issues?
A. Create a response team, consisting of representatives
from the compliance and audit department.
B. Create a response team, consisting of representatives
from compliance, audit, and any other relevant functional
department.
C. Create an investigation team, consisting of
representatives from compliance, audit, and any other
relevant functional department.
D. Create a prevention team, consisting of representatives
from compliance, audit, and any other relevant functional
department. Correct Answer B. Create a response team,
consisting of representatives from compliance, audit, and
any other relevant functional department.
A physician office laboratory is authorized to perform
urinalysis testing, including the microscopic analysis under
their Provider-Performed Microscopy Procedures (PPMP)
certification. It has been the physician's experience that
many of his patients that have urinalysis testing done also
requires the microscopic exam. Because of this and to be
able to provide better treatment, he has established an
office policy that for all urinalysis testing performed in his
office, the lab should also perform the microscopic test. Is
this a
,compliance risk?
A. Yes. Performing the microscopic test on all patients
when the results of the urinalysis are negative could be
considered medically unnecessary.
B. Yes. The physician must always order the code for the
urinalysis test with the microscopic exam to avoid
unbundling.
C. No. Because the physician is providing quality patient
care, there is no compliance risk.
D. No. The physici Correct Answer A. Yes. Performing the
microscopic test on all patients when the results of the
urinalysis are negative could be considered medically
unnecessary.
Billing companies should have written policies and
procedures that reflect and reinforce Federal and State
statutes. These policies must create a mechanism for the
billing or reimbursement staff to communicate effectively
and accurately with the health care provider. Which of the
following policies and procedures should a billing office
have in place to meet these needs?
A. Conclude that claims may be submitted when note has
been started but not yet finalized by the physician as long
as a signed affidavit is in place in the office granting the
staff power to provide coding based on preliminary
reports.
B. Provide incentives to billing and coding staff in the form
of compensation for productivity to ensure full revenue
recovery of all claims in a timely fashion.
, C. Establish and maintain a process for pre- and post-
submission review of claims to ensure claims submitted
for reimbursement accurately represent services Correct
Answer C. Establish and maintain a process for pre- and
post-submission review of claims to ensure claims
submitted for reimbursement accurately represent
services provided, are supported by sufficient
documentation and are in conformity with any applicable
coverage criteria for reimbursement
According to the OIG, medically unnecessary services
should only be billed to Medicare in what circumstance?
A. When directed to do so by the patient under ABN rules.
B. To receive a denial so that the claim can be submitted
to a secondary payer.
C. When the provider is willing to submit the
documentation to support the need for the service even
though it is likely that Medicare will deny in any event.
D. They should always be reported provided that an
appropriate modifier is used to signal that the services are
not medically necessary and should not be covered.
Correct Answer B. To receive a denial so that the claim
can be submitted to a secondary payer.
As part of a practice's compliance program, record
retention policies and procedures should be developed.
This policy and procedure should address the timeframes
associated with the retention of various records. When
developing a policy, which of the following statements
should be present?
ACTUAL EXAM QUESTIONS AND
DETAILED CORRECT ANSWERS 2024-
2025 | ALREADY PASSED
A compliance program's plan for communication should
include a provision for non-retaliation for reporting
fraudulent conduct. Which method below helps ensure
that an employee would be free from retribution?
A. A clearly defined chain of command for reporting
potentially fraudulent conduct
B. Guaranteed anonymity
C. Well-publicized disciplinary actions for retaliation
D. A policy that encourages reporting directly to the OIG
Correct Answer C. Well-publicized disciplinary actions for
retaliation
What does the HHS OIG suggest as possible warning
signs that non-compliance may exist?
A. Significant change in the number or type of claim
rejections.
B. Getting carrier newsletters pertaining to the types of
service that your practice bills.
C. Consistent use of certain codes.
D. Receipt of carrier requests for documentation. Correct
Answer A. Significant change in the number or type of
claim rejections.
,Having the ability to respond to issues enables a practice
to develop effective action plans to correct problems and
prevent future problems from occurring. What is one step
that can be taken to establish compliance effectiveness for
responding to and/or preventing compliance issues?
A. Create a response team, consisting of representatives
from the compliance and audit department.
B. Create a response team, consisting of representatives
from compliance, audit, and any other relevant functional
department.
C. Create an investigation team, consisting of
representatives from compliance, audit, and any other
relevant functional department.
D. Create a prevention team, consisting of representatives
from compliance, audit, and any other relevant functional
department. Correct Answer B. Create a response team,
consisting of representatives from compliance, audit, and
any other relevant functional department.
A physician office laboratory is authorized to perform
urinalysis testing, including the microscopic analysis under
their Provider-Performed Microscopy Procedures (PPMP)
certification. It has been the physician's experience that
many of his patients that have urinalysis testing done also
requires the microscopic exam. Because of this and to be
able to provide better treatment, he has established an
office policy that for all urinalysis testing performed in his
office, the lab should also perform the microscopic test. Is
this a
,compliance risk?
A. Yes. Performing the microscopic test on all patients
when the results of the urinalysis are negative could be
considered medically unnecessary.
B. Yes. The physician must always order the code for the
urinalysis test with the microscopic exam to avoid
unbundling.
C. No. Because the physician is providing quality patient
care, there is no compliance risk.
D. No. The physici Correct Answer A. Yes. Performing the
microscopic test on all patients when the results of the
urinalysis are negative could be considered medically
unnecessary.
Billing companies should have written policies and
procedures that reflect and reinforce Federal and State
statutes. These policies must create a mechanism for the
billing or reimbursement staff to communicate effectively
and accurately with the health care provider. Which of the
following policies and procedures should a billing office
have in place to meet these needs?
A. Conclude that claims may be submitted when note has
been started but not yet finalized by the physician as long
as a signed affidavit is in place in the office granting the
staff power to provide coding based on preliminary
reports.
B. Provide incentives to billing and coding staff in the form
of compensation for productivity to ensure full revenue
recovery of all claims in a timely fashion.
, C. Establish and maintain a process for pre- and post-
submission review of claims to ensure claims submitted
for reimbursement accurately represent services Correct
Answer C. Establish and maintain a process for pre- and
post-submission review of claims to ensure claims
submitted for reimbursement accurately represent
services provided, are supported by sufficient
documentation and are in conformity with any applicable
coverage criteria for reimbursement
According to the OIG, medically unnecessary services
should only be billed to Medicare in what circumstance?
A. When directed to do so by the patient under ABN rules.
B. To receive a denial so that the claim can be submitted
to a secondary payer.
C. When the provider is willing to submit the
documentation to support the need for the service even
though it is likely that Medicare will deny in any event.
D. They should always be reported provided that an
appropriate modifier is used to signal that the services are
not medically necessary and should not be covered.
Correct Answer B. To receive a denial so that the claim
can be submitted to a secondary payer.
As part of a practice's compliance program, record
retention policies and procedures should be developed.
This policy and procedure should address the timeframes
associated with the retention of various records. When
developing a policy, which of the following statements
should be present?
