CPCO Exam: Questions With Step-by-Step Solutions
What department helps to protect patients from unfair treatment or
discrimination?Office for Civil Rights Right Ans - Office for Civil Rights
What department helps to protect patients from unfair treatment or
discrimination? Right Ans - Office for Civil Rights
Which department is the largest inspector general's office in the federal
government? Right Ans - Office of the Inspector General
What term would be used for a practice that, either directly or indirectly,
results in unnecessary costs to the Medicare program? Right Ans - Abuse
Which federal government department is the OIG not responsible for
overseeing? Right Ans - Drug Enforcement Agency
In order for a compliance program to be effective, it needs to be: Right Ans
- Regularly reviewed and updated.
How many elements are required to have a successful compliance program?
Right Ans - Seven.
In what year did the OIG post guidance for hospitals? Right Ans - 1998
An effective compliance program can: Right Ans - Help create financial
success, customer loyalty, community support and employee satisfaction.
There are many benefits of having an effective compliance program. One such
benefit is: Right Ans - It shows that the practice is making a good faith
effort to be compliant.
Fraud, waste and abuse are all areas that must be controlled when providing
services to beneficiaries. Fraudulent billing is: Right Ans - A willful act.
All expenses related to developing and implementing a compliance program
are considered the cost of doing business and are tax deductible for the
organization, except: Right Ans - When the expenses are the result of the
imposition of a penalty.
,Payers expect all providers to refund monies tat are over =payments. By law,
this must occur within ... Right Ans - 60 days of identification of
overpayment.
Compliance programs are ... Right Ans - More dangerous if they are
developed but not implemented.
The seven core elements used in the OIg Compliance Program Guidance are
also used by the United States Sentencing Commission (USSC) for which
guidelines? Right Ans - Federal sentencing guidelines (FSGs)
What is the most important aspect of a compliance program? Right Ans -
Implementation.
What is considered an appropriate start to implementing an effective
compliance program for small physician group practices with limited
resources? Right Ans - Adopt only those components which, based on the
practice's specific history with billing problems and other compliance issues,
are most likely to provide an identifiable benefit.
OIG Compliance Program Guidance acknowledges patient care as: Right
Ans - The first priority of a physician practice.
Because of the changing nature of healthcare regulation, the compliance
program ... Right Ans - Is a "work in progress."
When do we need an outside consultant and/or legal counsel? Right Ans -
There is no requirement to hire a consultant or counsel; however, having
assistance from one or both may be beneficial during certain phases or
development and/or if issues arise.
What should not be ignored and may require necessary policy measures to
prevent avoidable recurrence? Right Ans - Risk areas
What third-party plays a critical role in accurate billing and reimbursement?
Right Ans - Billing agencies
, What should be readily accessible to all coding staff? Right Ans - All
essential coding resources
Why should compliance officers set disciplinary policies for non-compliance?
Right Ans - Employees should know the consequences for non-compliance of
set policies.
A billing company's written policies and procedures should reflect current:
Right Ans - Federal and state statutes
How many states currently require nursing facilities to perform a background
check of state records for direct-access employees? Right Ans - 43
How many states require nursing facilities to perform FBI checks on
employees? Right Ans - 10
SNFs are Medicare certified facilities that provide skilled nursing or
rehabilitative care under Medicare Parts: Right Ans - A & B
What can providers review that will help them understand the compliance
requirements of a clinical lab? Right Ans - OIG's Clinical Lab Guidance
What law does not require that nursing facilities conduct state FBI criminal
background checks? Right Ans - Federal law
The Affordable Care Act requires providers to refund an overpayment to
Medicare within how many days of identification? Right Ans - 60
In a qui tam action, the relator is entitled to receive a monetary settlement
between: Right Ans - 15-30%
The OIG works within which agency? Right Ans - HHS
After hiring, how often should providers check to make sure employees are
not on the OIG List of Excluded Individuals? Right Ans - Monthly
Under what circumstances can a relator not file or pursue a qui tam action?
Right Ans - The qui tam action is based upon information that has been
disclosed to the public
What department helps to protect patients from unfair treatment or
discrimination?Office for Civil Rights Right Ans - Office for Civil Rights
What department helps to protect patients from unfair treatment or
discrimination? Right Ans - Office for Civil Rights
Which department is the largest inspector general's office in the federal
government? Right Ans - Office of the Inspector General
What term would be used for a practice that, either directly or indirectly,
results in unnecessary costs to the Medicare program? Right Ans - Abuse
Which federal government department is the OIG not responsible for
overseeing? Right Ans - Drug Enforcement Agency
In order for a compliance program to be effective, it needs to be: Right Ans
- Regularly reviewed and updated.
How many elements are required to have a successful compliance program?
Right Ans - Seven.
In what year did the OIG post guidance for hospitals? Right Ans - 1998
An effective compliance program can: Right Ans - Help create financial
success, customer loyalty, community support and employee satisfaction.
There are many benefits of having an effective compliance program. One such
benefit is: Right Ans - It shows that the practice is making a good faith
effort to be compliant.
Fraud, waste and abuse are all areas that must be controlled when providing
services to beneficiaries. Fraudulent billing is: Right Ans - A willful act.
All expenses related to developing and implementing a compliance program
are considered the cost of doing business and are tax deductible for the
organization, except: Right Ans - When the expenses are the result of the
imposition of a penalty.
,Payers expect all providers to refund monies tat are over =payments. By law,
this must occur within ... Right Ans - 60 days of identification of
overpayment.
Compliance programs are ... Right Ans - More dangerous if they are
developed but not implemented.
The seven core elements used in the OIg Compliance Program Guidance are
also used by the United States Sentencing Commission (USSC) for which
guidelines? Right Ans - Federal sentencing guidelines (FSGs)
What is the most important aspect of a compliance program? Right Ans -
Implementation.
What is considered an appropriate start to implementing an effective
compliance program for small physician group practices with limited
resources? Right Ans - Adopt only those components which, based on the
practice's specific history with billing problems and other compliance issues,
are most likely to provide an identifiable benefit.
OIG Compliance Program Guidance acknowledges patient care as: Right
Ans - The first priority of a physician practice.
Because of the changing nature of healthcare regulation, the compliance
program ... Right Ans - Is a "work in progress."
When do we need an outside consultant and/or legal counsel? Right Ans -
There is no requirement to hire a consultant or counsel; however, having
assistance from one or both may be beneficial during certain phases or
development and/or if issues arise.
What should not be ignored and may require necessary policy measures to
prevent avoidable recurrence? Right Ans - Risk areas
What third-party plays a critical role in accurate billing and reimbursement?
Right Ans - Billing agencies
, What should be readily accessible to all coding staff? Right Ans - All
essential coding resources
Why should compliance officers set disciplinary policies for non-compliance?
Right Ans - Employees should know the consequences for non-compliance of
set policies.
A billing company's written policies and procedures should reflect current:
Right Ans - Federal and state statutes
How many states currently require nursing facilities to perform a background
check of state records for direct-access employees? Right Ans - 43
How many states require nursing facilities to perform FBI checks on
employees? Right Ans - 10
SNFs are Medicare certified facilities that provide skilled nursing or
rehabilitative care under Medicare Parts: Right Ans - A & B
What can providers review that will help them understand the compliance
requirements of a clinical lab? Right Ans - OIG's Clinical Lab Guidance
What law does not require that nursing facilities conduct state FBI criminal
background checks? Right Ans - Federal law
The Affordable Care Act requires providers to refund an overpayment to
Medicare within how many days of identification? Right Ans - 60
In a qui tam action, the relator is entitled to receive a monetary settlement
between: Right Ans - 15-30%
The OIG works within which agency? Right Ans - HHS
After hiring, how often should providers check to make sure employees are
not on the OIG List of Excluded Individuals? Right Ans - Monthly
Under what circumstances can a relator not file or pursue a qui tam action?
Right Ans - The qui tam action is based upon information that has been
disclosed to the public
