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CPCO CERTIFICATION PRACTICE EXAM
2025|ACTUAL EXAM WITH 100% VERIFIED
QUESTIONS AND CORRECT ANSWERS |
ALREADY GRADED A+
C. Health Care Fraud and Abuse Control Program (HCFAC) - CORRECT-ANSWER-
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)
D. Health Care Civil Penalties Law
A. Promote an organizational culture that encourages ethical conduct and a
commitment to compliance with the law. - CORRECT-ANSWER-According to the
Federal Sentencing Guidelines, "To have an effective compliance and ethics
, Page |2
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.
B. Tailor those materials to the physician practice where they will be applied. -
CORRECT-ANSWER-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
conduct.
, Page |3
B. For any services billed, documentation must be present in the patient's medical
record to support the services. - CORRECT-ANSWER-As the compliance contact
for your physician practice, you are charged with 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.
B. To receive a denial so that the claim can be submitted to a secondary payer. -
CORRECT-ANSWER-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.
CPCO CERTIFICATION PRACTICE EXAM
2025|ACTUAL EXAM WITH 100% VERIFIED
QUESTIONS AND CORRECT ANSWERS |
ALREADY GRADED A+
C. Health Care Fraud and Abuse Control Program (HCFAC) - CORRECT-ANSWER-
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)
D. Health Care Civil Penalties Law
A. Promote an organizational culture that encourages ethical conduct and a
commitment to compliance with the law. - CORRECT-ANSWER-According to the
Federal Sentencing Guidelines, "To have an effective compliance and ethics
, Page |2
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.
B. Tailor those materials to the physician practice where they will be applied. -
CORRECT-ANSWER-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
conduct.
, Page |3
B. For any services billed, documentation must be present in the patient's medical
record to support the services. - CORRECT-ANSWER-As the compliance contact
for your physician practice, you are charged with 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.
B. To receive a denial so that the claim can be submitted to a secondary payer. -
CORRECT-ANSWER-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.
