Page | 1
CPCO Certification Exam Questions and Verified
Answers
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
Ans: 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.
Ans: 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.
, Page | 2
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.
Ans: B. Tailor those materials to the physician practice where they will be
applied.
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.
Ans: B. For any services billed, documentation must be present in the
patient's medical record to support the services.
City Orthopedics, a large physician group practice employs several physician
assistants and nurse practitioners. There have been several questions by the
physicians on how incident to services should be billed. The compliance officer
has called the Medicare Administrative Contractor for the practice and was given
some information on how incident to services should be billed. Because the
practice will be relying on the information received from the Medicare
Administrative Contractor, what steps should the compliance officer take at the
conclusion of the call according to the OIG Compliance Guidance for Individual
and Small Group Physician Practices?
A. Call someone else at the Medicare Administrative Contractor to confirm the
information received.
B. Send a letter to CMS to confirm the information provided by the Medicare
Administrative Contractor is correct.
C. Both A and B
, Page | 3
D. Document the conversation and retain th
Ans: D. Document the conversation and retain the records.
Developing effective compliance policies and procedures is an important part of
any compliance program. To help your practice mitigate compliance risk,
policies and procedures should:
A. Only be one page long to promote understanding by all staff.
B. Be sure any timeframes or requirements listed can be accomplished given the
practice's resources.
C. Be written by consultants because they are more familiar with the variety of
healthcare regulations that apply to the practice.
D. Both B and C
Ans: B. Be sure any timeframes or requirements listed can be accomplished
given the practice's resources.
Select the best phrase from the list below to complete the following policy
statement: Centennial Medical Associates is committed to following Federal,
State, and Local laws, rules, guidelines, and regulations. To promote this effort,
Centennial Medical Associates will perform claims audits at least on an annual
basis to ____________________.
A. Maximize reimbursement for the services performed.
B. Optimize reimbursement for the services performed.
C. Verify accuracy of coding and reimbursement for the services performed.
D. Ensure all services are submitted for reimbursement.
Ans: C. Verify accuracy of coding and reimbursement for the services
performed.
You have just been identified as the compliance officer at your practice. The OIG
Compliance Guidance for Individual and Small Group Physician Practices
suggests six specific duties that may be assigned to you. What is one of those
duties?
A. Reviewing reports to see that new employees and vendors have been checked
against the OIG's list of excluded individuals and entities.
CPCO Certification Exam Questions and Verified
Answers
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
Ans: 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.
Ans: 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.
, Page | 2
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.
Ans: B. Tailor those materials to the physician practice where they will be
applied.
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.
Ans: B. For any services billed, documentation must be present in the
patient's medical record to support the services.
City Orthopedics, a large physician group practice employs several physician
assistants and nurse practitioners. There have been several questions by the
physicians on how incident to services should be billed. The compliance officer
has called the Medicare Administrative Contractor for the practice and was given
some information on how incident to services should be billed. Because the
practice will be relying on the information received from the Medicare
Administrative Contractor, what steps should the compliance officer take at the
conclusion of the call according to the OIG Compliance Guidance for Individual
and Small Group Physician Practices?
A. Call someone else at the Medicare Administrative Contractor to confirm the
information received.
B. Send a letter to CMS to confirm the information provided by the Medicare
Administrative Contractor is correct.
C. Both A and B
, Page | 3
D. Document the conversation and retain th
Ans: D. Document the conversation and retain the records.
Developing effective compliance policies and procedures is an important part of
any compliance program. To help your practice mitigate compliance risk,
policies and procedures should:
A. Only be one page long to promote understanding by all staff.
B. Be sure any timeframes or requirements listed can be accomplished given the
practice's resources.
C. Be written by consultants because they are more familiar with the variety of
healthcare regulations that apply to the practice.
D. Both B and C
Ans: B. Be sure any timeframes or requirements listed can be accomplished
given the practice's resources.
Select the best phrase from the list below to complete the following policy
statement: Centennial Medical Associates is committed to following Federal,
State, and Local laws, rules, guidelines, and regulations. To promote this effort,
Centennial Medical Associates will perform claims audits at least on an annual
basis to ____________________.
A. Maximize reimbursement for the services performed.
B. Optimize reimbursement for the services performed.
C. Verify accuracy of coding and reimbursement for the services performed.
D. Ensure all services are submitted for reimbursement.
Ans: C. Verify accuracy of coding and reimbursement for the services
performed.
You have just been identified as the compliance officer at your practice. The OIG
Compliance Guidance for Individual and Small Group Physician Practices
suggests six specific duties that may be assigned to you. What is one of those
duties?
A. Reviewing reports to see that new employees and vendors have been checked
against the OIG's list of excluded individuals and entities.
