CPCO CERTIFICATION EXAM QUESTIONS AND ANSWERS
UPDATED 2024/2025 A COMPLETE SOLUTION WITH
100% CORRECT VERIFIED ANSWERS BEST GRADED TO
SCORE A+ FOR SUCCESS
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 ANSWERS 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?
,CPCO CERTIFICATION EXAM QUESTIONS AND ANSWERS
UPDATED 2024/2025 A COMPLETE SOLUTION WITH
100% CORRECT VERIFIED ANSWERS BEST GRADED TO
SCORE A+ FOR SUCCESS
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 ANSWERS 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 ANSWERS B. To receive a denial so that the claim can be submitted to
a secondary payer.
,CPCO CERTIFICATION EXAM QUESTIONS AND ANSWERS
UPDATED 2024/2025 A COMPLETE SOLUTION WITH
100% CORRECT VERIFIED ANSWERS BEST GRADED TO
SCORE A+ FOR SUCCESS
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?
A. Specific records must be retained based upon the most stringent requirement
identified in federal or state law, or internal policies and procedures.
B. Records will be retained based upon federal requirements as this supersedes
state law or internal policies/procedures.
C. Records will be retained based upon state requirements as this supersedes
federal law or internal policies/procedures.
D. Records will be retained based upon internal policies/procedures as this
supersedes both federal and state laws. - CORRECT ANSWERS A. Specific records
must be retained based upon the most stringent requirement identified in federal
or state law, or internal policies and procedures.
Under the Health Insurance Portability and 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)
, CPCO CERTIFICATION EXAM QUESTIONS AND ANSWERS
UPDATED 2024/2025 A COMPLETE SOLUTION WITH
100% CORRECT VERIFIED ANSWERS BEST GRADED TO
SCORE A+ FOR SUCCESS
D. Health Care Civil Penalties Law - CORRECT ANSWERS C. Health Care Fraud and
Abuse Control Program (HCFAC)
According to the Federal Sentencing Guidelines, "To have an effective 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. - CORRECT
ANSWERS A. Promote an organizational culture that encourages ethical conduct
and a commitment to compliance with the law.
If a physician practice uses another entity's standards 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
UPDATED 2024/2025 A COMPLETE SOLUTION WITH
100% CORRECT VERIFIED ANSWERS BEST GRADED TO
SCORE A+ FOR SUCCESS
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 ANSWERS 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?
,CPCO CERTIFICATION EXAM QUESTIONS AND ANSWERS
UPDATED 2024/2025 A COMPLETE SOLUTION WITH
100% CORRECT VERIFIED ANSWERS BEST GRADED TO
SCORE A+ FOR SUCCESS
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 ANSWERS 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 ANSWERS B. To receive a denial so that the claim can be submitted to
a secondary payer.
,CPCO CERTIFICATION EXAM QUESTIONS AND ANSWERS
UPDATED 2024/2025 A COMPLETE SOLUTION WITH
100% CORRECT VERIFIED ANSWERS BEST GRADED TO
SCORE A+ FOR SUCCESS
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?
A. Specific records must be retained based upon the most stringent requirement
identified in federal or state law, or internal policies and procedures.
B. Records will be retained based upon federal requirements as this supersedes
state law or internal policies/procedures.
C. Records will be retained based upon state requirements as this supersedes
federal law or internal policies/procedures.
D. Records will be retained based upon internal policies/procedures as this
supersedes both federal and state laws. - CORRECT ANSWERS A. Specific records
must be retained based upon the most stringent requirement identified in federal
or state law, or internal policies and procedures.
Under the Health Insurance Portability and 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)
, CPCO CERTIFICATION EXAM QUESTIONS AND ANSWERS
UPDATED 2024/2025 A COMPLETE SOLUTION WITH
100% CORRECT VERIFIED ANSWERS BEST GRADED TO
SCORE A+ FOR SUCCESS
D. Health Care Civil Penalties Law - CORRECT ANSWERS C. Health Care Fraud and
Abuse Control Program (HCFAC)
According to the Federal Sentencing Guidelines, "To have an effective 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. - CORRECT
ANSWERS A. Promote an organizational culture that encourages ethical conduct
and a commitment to compliance with the law.
If a physician practice uses another entity's standards 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
