CPCO STUDY GUIDE UPDATED
ACTUAL Exam Questions and CORRECT
Answers
One of the most important elements of an effective compliance program is to have a compliance
officer or committee who is__________. - CORRECT ANSWER - 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 ______________? -
CORRECT ANSWER - fraud
Joan, as an employee of a healthcare organization, has _________to report erroneous conduct,
without repercussions, so that it may be corrected immediately - CORRECT ANSWER - duty
person who exposes misconduct, alleged dishonest or illegal activity occurring in an organization
is called a______________? - CORRECT ANSWER - relator
The compliance program will flounder if employees of the organization are not aware of
_________? - CORRECT ANSWER - 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 _________? - CORRECT ANSWER - 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? -
CORRECT ANSWER - 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 _________________? - CORRECT ANSWER - detects
and prevent fraudulent, abusive and wasteful activities
,Tim, the Compliance Officer for XYZ Community Hospital, should report to whom? -
CORRECT ANSWER - 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? - CORRECT ANSWER - double billing
The OIG has described seven basic components of an effective compliance program for a small
physician practice that are based from the _______________? - CORRECT ANSWER -
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 ____________? -
CORRECT ANSWER - 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 _______________? - CORRECT
ANSWER - 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? -
CORRECT ANSWER - 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? - CORRECT ANSWER - intra-office or USPS mail
Tim at XYZ wants to conduct a baseline audit to help determine? - CORRECT ANSWER -
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? - CORRECT ANSWER - 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_____________. - CORRECT ANSWER - 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 _________? - CORRECT ANSWER - The Code of conduct
How often should the Tim, Compliance Officer for XYZ Community Hospital update the
compliance program and plan? - CORRECT ANSWER - 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? - CORRECT ANSWER - 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 _____________. - CORRECT ANSWER - Joint
ventures
The following is not a level of non-compliance: - CORRECT ANSWER - Mistake in billing
For potential criminal violations, a practice should have immediate discussions with a criminal
attorney who - CORRECT ANSWER - Is well versed in Healthcare Fraud and Abuse law
, The Compliance Officer's main two responsibilities are to ____________the
practice/organization's compliance program. - CORRECT ANSWER - 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? - CORRECT ANSWER - 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? - CORRECT ANSWER -
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. - CORRECT ANSWER - 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? - CORRECT ANSWER - Nursing Facilities
What is (are) considered a significant element(s) in fraud? - CORRECT ANSWER -
Knowingly and Intent
Department of Labor requires compliance with employee and employer laws including: -
CORRECT ANSWER - FLSA, OSHA, CRA, ERISA
Which government branch was created to fight waste, fraud and abuse in all federal health care
programs especially Medicare, Medicaid? - CORRECT ANSWER - Office of Inspector
General (OIG)
ACTUAL Exam Questions and CORRECT
Answers
One of the most important elements of an effective compliance program is to have a compliance
officer or committee who is__________. - CORRECT ANSWER - 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 ______________? -
CORRECT ANSWER - fraud
Joan, as an employee of a healthcare organization, has _________to report erroneous conduct,
without repercussions, so that it may be corrected immediately - CORRECT ANSWER - duty
person who exposes misconduct, alleged dishonest or illegal activity occurring in an organization
is called a______________? - CORRECT ANSWER - relator
The compliance program will flounder if employees of the organization are not aware of
_________? - CORRECT ANSWER - 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 _________? - CORRECT ANSWER - 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? -
CORRECT ANSWER - 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 _________________? - CORRECT ANSWER - detects
and prevent fraudulent, abusive and wasteful activities
,Tim, the Compliance Officer for XYZ Community Hospital, should report to whom? -
CORRECT ANSWER - 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? - CORRECT ANSWER - double billing
The OIG has described seven basic components of an effective compliance program for a small
physician practice that are based from the _______________? - CORRECT ANSWER -
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 ____________? -
CORRECT ANSWER - 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 _______________? - CORRECT
ANSWER - 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? -
CORRECT ANSWER - 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? - CORRECT ANSWER - intra-office or USPS mail
Tim at XYZ wants to conduct a baseline audit to help determine? - CORRECT ANSWER -
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? - CORRECT ANSWER - 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_____________. - CORRECT ANSWER - 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 _________? - CORRECT ANSWER - The Code of conduct
How often should the Tim, Compliance Officer for XYZ Community Hospital update the
compliance program and plan? - CORRECT ANSWER - 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? - CORRECT ANSWER - 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 _____________. - CORRECT ANSWER - Joint
ventures
The following is not a level of non-compliance: - CORRECT ANSWER - Mistake in billing
For potential criminal violations, a practice should have immediate discussions with a criminal
attorney who - CORRECT ANSWER - Is well versed in Healthcare Fraud and Abuse law
, The Compliance Officer's main two responsibilities are to ____________the
practice/organization's compliance program. - CORRECT ANSWER - 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? - CORRECT ANSWER - 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? - CORRECT ANSWER -
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. - CORRECT ANSWER - 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? - CORRECT ANSWER - Nursing Facilities
What is (are) considered a significant element(s) in fraud? - CORRECT ANSWER -
Knowingly and Intent
Department of Labor requires compliance with employee and employer laws including: -
CORRECT ANSWER - FLSA, OSHA, CRA, ERISA
Which government branch was created to fight waste, fraud and abuse in all federal health care
programs especially Medicare, Medicaid? - CORRECT ANSWER - Office of Inspector
General (OIG)
