CPCO Study Guide: Questions With Easy-to-Follow
Solutions
One of the most important elements of an effective compliance program is to
have a compliance officer or committee who is__________. Right Ans -
empowered
If an employee, provider or anyone that deals with Federal or State healthcare
dollars has intent to receive payment for services not legitimately rendered
this is considered ______________? Right Ans - fraud
Joan, as an employee of a healthcare organization, has _________to report
erroneous conduct, without repercussions, so that it may be corrected
immediately Right Ans - duty
person who exposes misconduct, alleged dishonest or illegal activity occurring
in an organization is called a______________? Right Ans - relator
The compliance program will flounder if employees of the organization are
not aware of _________? Right Ans - laws and regulations that pertain to their
specific job descriptions
When physicians (or their staff) make billing mistakes and errors the most
important thing to do is _________? Right Ans - Send a refund
Judy is the Compliance Officer for Apple Medical Group. The practice is a small
group of providers. Judy wants to have an open door policy as suggested by
the OIG, thus she will? Right Ans - Post notices of up-to-date compliance
information on the employee bulletin board
Participants in the Federal healthcare programs have an obligation to take
measures, such as instituting a compliance program, to _________________?
Right Ans - detects and prevent fraudulent, abusive and wasteful activities
Tim, the Compliance Officer for XYZ Community Hospital, should report to
whom? Right Ans - CEO or Board
,The biller at XYZ Community Hospital wants to win the award every month
for posting the most insurance checks. Instead of giving the claims 30-60 days
to clear, she bills them again at the end of the month. This is an example of?
Right Ans - double billing
The OIG has described seven basic components of an effective compliance
program for a small physician practice that are based from the _______________?
Right Ans - Federal Sentencing Guidelines
Kim, Compliance Officer for ABC Provider Group, created a compliance plan
and policy a 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. The Non-Compliance has ____________? Right Ans - created
a big risk of the group and Kim needs to make sure that everyone knows about
the risk of not following the compliance plan
A high-level statement or plan that embraces an organization's general beliefs,
goals, objectives and acceptable procedure for a specified subject area is a
_______________? Right Ans - policy
Kim is the Compliance Officer for ABC Provider Group. Kim has read the OIG
Compliance Program Guidance that acknowledges patient care as the first
priority of a physician practice. As the Compliance Officer (CO), Kim should
implement what type of compliance model? Right Ans - A "patients first"
It is important to educate employees of the methods they may utilize to
directly notify and communicate issues of suspected areas of non-compliance.
What is considered a best practice method of anonymous reporting? Right
Ans - intra-office or USPS mail
Tim at XYZ wants to conduct a baseline audit to help determine? Right Ans
- areas of the billing department that might be in compliance
When the term Open Door Policy is used in reference to the Effective
Communication, what is this referring to? Right Ans - The Compliance
Officer is accessible to all employees via many methods of communication
When Kim from ABC Provider Group is conducting a risk assessment, one of
the most important and key sources of information that Kim as the
,Compliance Officer should utilize is_____________. Right Ans - the Office of
Inspector General's Annual Work Plan
The mission statement of the healthcare organization and a statement of why
they are in business are also known as _________? Right Ans - The Code of
conduct
How often should the Tim, Compliance Officer for XYZ Community Hospital
update the compliance program and plan? Right Ans - As laws and
regulations change; and at least annually
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
noncompliance activity? Right Ans - Perform a baseline assessment of the
employee's competency scores to determine if additional training is required
ABC Provider Group and Apple Medical Group agree to pool their resources
for the purpose of accomplishing a specific task. This is called _____________.
Right Ans - Joint ventures
The following is not a level of non-compliance: Right Ans - Mistake in
billing
For potential criminal violations, a practice should have immediate
discussions with a criminal attorney who Right Ans - Is well versed in
Healthcare Fraud and Abuse law
The Compliance Officer's main two responsibilities are to ____________the
practice/organization's compliance program. Right Ans - develops and
then implement
Judy is the Compliance Officer for Apple Medical Group. The providers of the
group ask Judy to design a new Compliance Plan. Should Judy ask some other
practices in town for a copy of their Compliance Plan? Do all Compliance
Programs have to be the same regardless of the practice size or specialty?
Why? Right Ans - No, compliance programs need to be tailored to fit the
unique needs of every organization or physician practice
, USSC is important as it related to the Federal Sentencing Guidelines and thus
related to the core elements of compliance. What does the USSC acronym
stand for? Right Ans - United States Sentencing Commission
Kathy, the Compliance Officer at a small provider office, is notified that a non-
English speaking patient will be arriving today. A LEP person/patient who
needs an interpreter to translate to and from the person's primary language
must be provided. Right Ans - at no cost to the patient or insurance carrier
In addition to hospitals, what other type of facility did the OIG provide
supplemental compliance program guidance for? Right Ans - Nursing
Facilities
What is (are) considered a significant element(s) in fraud? Right Ans -
Knowingly and Intent
Department of Labor requires compliance with employee and employer laws
including: Right Ans - FLSA, OSHA, CRA, ERISA
Which government branch was created to fight waste, fraud and abuse in all
federal health care programs especially Medicare, Medicaid? Right Ans -
Office of Inspector General (OIG)
Dr. X is a very through provider. He always runs a full blood panel on each
patient every year for their physical. This is an example of: Right Ans -
Waste
The current strategy for the DOJ includes all of the following except: Right
Ans - Ensure the privacy of patient records with the use of HIPAA
Which options are key elements for an effective Compliance Program?
I. Conducting external auditing and monitoring.
II. Implementing compliance and practice standards.
III. Designating a Compliance Officer or contact.
IV. Outsourcing appropriate training and education.
V. Responding appropriately to detected offenses and developing and
implementing corrective action.
VI. Developing open lines of communication.
Solutions
One of the most important elements of an effective compliance program is to
have a compliance officer or committee who is__________. Right Ans -
empowered
If an employee, provider or anyone that deals with Federal or State healthcare
dollars has intent to receive payment for services not legitimately rendered
this is considered ______________? Right Ans - fraud
Joan, as an employee of a healthcare organization, has _________to report
erroneous conduct, without repercussions, so that it may be corrected
immediately Right Ans - duty
person who exposes misconduct, alleged dishonest or illegal activity occurring
in an organization is called a______________? Right Ans - relator
The compliance program will flounder if employees of the organization are
not aware of _________? Right Ans - laws and regulations that pertain to their
specific job descriptions
When physicians (or their staff) make billing mistakes and errors the most
important thing to do is _________? Right Ans - Send a refund
Judy is the Compliance Officer for Apple Medical Group. The practice is a small
group of providers. Judy wants to have an open door policy as suggested by
the OIG, thus she will? Right Ans - Post notices of up-to-date compliance
information on the employee bulletin board
Participants in the Federal healthcare programs have an obligation to take
measures, such as instituting a compliance program, to _________________?
Right Ans - detects and prevent fraudulent, abusive and wasteful activities
Tim, the Compliance Officer for XYZ Community Hospital, should report to
whom? Right Ans - CEO or Board
,The biller at XYZ Community Hospital wants to win the award every month
for posting the most insurance checks. Instead of giving the claims 30-60 days
to clear, she bills them again at the end of the month. This is an example of?
Right Ans - double billing
The OIG has described seven basic components of an effective compliance
program for a small physician practice that are based from the _______________?
Right Ans - Federal Sentencing Guidelines
Kim, Compliance Officer for ABC Provider Group, created a compliance plan
and policy a 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. The Non-Compliance has ____________? Right Ans - created
a big risk of the group and Kim needs to make sure that everyone knows about
the risk of not following the compliance plan
A high-level statement or plan that embraces an organization's general beliefs,
goals, objectives and acceptable procedure for a specified subject area is a
_______________? Right Ans - policy
Kim is the Compliance Officer for ABC Provider Group. Kim has read the OIG
Compliance Program Guidance that acknowledges patient care as the first
priority of a physician practice. As the Compliance Officer (CO), Kim should
implement what type of compliance model? Right Ans - A "patients first"
It is important to educate employees of the methods they may utilize to
directly notify and communicate issues of suspected areas of non-compliance.
What is considered a best practice method of anonymous reporting? Right
Ans - intra-office or USPS mail
Tim at XYZ wants to conduct a baseline audit to help determine? Right Ans
- areas of the billing department that might be in compliance
When the term Open Door Policy is used in reference to the Effective
Communication, what is this referring to? Right Ans - The Compliance
Officer is accessible to all employees via many methods of communication
When Kim from ABC Provider Group is conducting a risk assessment, one of
the most important and key sources of information that Kim as the
,Compliance Officer should utilize is_____________. Right Ans - the Office of
Inspector General's Annual Work Plan
The mission statement of the healthcare organization and a statement of why
they are in business are also known as _________? Right Ans - The Code of
conduct
How often should the Tim, Compliance Officer for XYZ Community Hospital
update the compliance program and plan? Right Ans - As laws and
regulations change; and at least annually
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
noncompliance activity? Right Ans - Perform a baseline assessment of the
employee's competency scores to determine if additional training is required
ABC Provider Group and Apple Medical Group agree to pool their resources
for the purpose of accomplishing a specific task. This is called _____________.
Right Ans - Joint ventures
The following is not a level of non-compliance: Right Ans - Mistake in
billing
For potential criminal violations, a practice should have immediate
discussions with a criminal attorney who Right Ans - Is well versed in
Healthcare Fraud and Abuse law
The Compliance Officer's main two responsibilities are to ____________the
practice/organization's compliance program. Right Ans - develops and
then implement
Judy is the Compliance Officer for Apple Medical Group. The providers of the
group ask Judy to design a new Compliance Plan. Should Judy ask some other
practices in town for a copy of their Compliance Plan? Do all Compliance
Programs have to be the same regardless of the practice size or specialty?
Why? Right Ans - No, compliance programs need to be tailored to fit the
unique needs of every organization or physician practice
, USSC is important as it related to the Federal Sentencing Guidelines and thus
related to the core elements of compliance. What does the USSC acronym
stand for? Right Ans - United States Sentencing Commission
Kathy, the Compliance Officer at a small provider office, is notified that a non-
English speaking patient will be arriving today. A LEP person/patient who
needs an interpreter to translate to and from the person's primary language
must be provided. Right Ans - at no cost to the patient or insurance carrier
In addition to hospitals, what other type of facility did the OIG provide
supplemental compliance program guidance for? Right Ans - Nursing
Facilities
What is (are) considered a significant element(s) in fraud? Right Ans -
Knowingly and Intent
Department of Labor requires compliance with employee and employer laws
including: Right Ans - FLSA, OSHA, CRA, ERISA
Which government branch was created to fight waste, fraud and abuse in all
federal health care programs especially Medicare, Medicaid? Right Ans -
Office of Inspector General (OIG)
Dr. X is a very through provider. He always runs a full blood panel on each
patient every year for their physical. This is an example of: Right Ans -
Waste
The current strategy for the DOJ includes all of the following except: Right
Ans - Ensure the privacy of patient records with the use of HIPAA
Which options are key elements for an effective Compliance Program?
I. Conducting external auditing and monitoring.
II. Implementing compliance and practice standards.
III. Designating a Compliance Officer or contact.
IV. Outsourcing appropriate training and education.
V. Responding appropriately to detected offenses and developing and
implementing corrective action.
VI. Developing open lines of communication.
