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CPCO Chapter 1 Review Questions and Verified
Answers
Dr. Smith had some billing issues at his medical office. He agreed to work with
the OIG to correct the issues. What does the term "CCA" refer to so that you (the
Compliance Officer) can explain to Dr. Smith?
Ans: Certification of Compliance Agreement in which providers agree to
continue to operate their existing compliance program.
Response Feedback: CCA is a Certification of Compliance Agreement which
requires providers to certify they will continue to operate their existing
compliance programs for a fixed term.
Hospital compliance guidance was published by the OIG in February 1998.
When was the supplemental compliance guidance for hospitals published?
Ans: 2005
Response Feedback:
Compliance Program Guidance for Hospitals (63 Fed. Reg. 8987; February
23, 1998)
Supplemental Compliance Program Guidance for Hospitals (70 Fed. Reg.
4858; January 31, 2005)
Kim is the Compliance Officer for a large provider group. One of the billers for
the group enters codes from the encounter form every evening before she goes
home and then finishes in the morning when she returns. She often enters an
encounter twice. She usually catches the mistake when the insurance checks are
sent to the office and returns the overpayment to the insurance carrier. This is an
example of:
Ans: Abuse
Response Feedback:
CMS goes on to define abuse as "practices that, either directly or indirectly,
result in unnecessary costs to the Medicare Program." Improper billing
practices.
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Justin works at the local hospital in the billing department. He wants to learn
more about the agency that fights Medicare Fraud. Which is the best answer
below?
Ans: Office of Inspector General (OIG)
Response Feedback:
Since its 1976 establishment, OIG has been at the forefront of the Nation's
efforts to fight waste, fraud and abuse in Medicare, Medicaid and more than
300 other HHS programs.
According to Inspector General Daniel Levinson, what can help reduce
enforcement on a provider from a CIA to a CCA?
Ans: provider has a robust and effective compliance program
Response Feedback:
Inspector General Daniel Levinson disseminated an Open Letter to
Healthcare Providers in 2006, in which he discussed the current
enforcement and noted that, "many providers have independently developed
robust and effective compliance programs, which include internal auditing
mechanisms. In appropriate cases, we have agreed to reduce the obligation
on providers settling health care fraud matters by entering into Certification
of Compliance Agreements (CCAs), rather than more extensive CIAs.
In addition to hospitals, what other type of facility did the OIG provide
supplemental compliance program guidance for?
Ans: Nursing Facilities
Response Feedback:
Supplemental compliance program guidance was published for nursing
facilities in September 2008.
CPUP was the first large fraud case that involved a teaching hospital where
Residents and Fellows worked and was located in:
CPCO Chapter 1 Review Questions and Verified
Answers
Dr. Smith had some billing issues at his medical office. He agreed to work with
the OIG to correct the issues. What does the term "CCA" refer to so that you (the
Compliance Officer) can explain to Dr. Smith?
Ans: Certification of Compliance Agreement in which providers agree to
continue to operate their existing compliance program.
Response Feedback: CCA is a Certification of Compliance Agreement which
requires providers to certify they will continue to operate their existing
compliance programs for a fixed term.
Hospital compliance guidance was published by the OIG in February 1998.
When was the supplemental compliance guidance for hospitals published?
Ans: 2005
Response Feedback:
Compliance Program Guidance for Hospitals (63 Fed. Reg. 8987; February
23, 1998)
Supplemental Compliance Program Guidance for Hospitals (70 Fed. Reg.
4858; January 31, 2005)
Kim is the Compliance Officer for a large provider group. One of the billers for
the group enters codes from the encounter form every evening before she goes
home and then finishes in the morning when she returns. She often enters an
encounter twice. She usually catches the mistake when the insurance checks are
sent to the office and returns the overpayment to the insurance carrier. This is an
example of:
Ans: Abuse
Response Feedback:
CMS goes on to define abuse as "practices that, either directly or indirectly,
result in unnecessary costs to the Medicare Program." Improper billing
practices.
, Page | 2
Justin works at the local hospital in the billing department. He wants to learn
more about the agency that fights Medicare Fraud. Which is the best answer
below?
Ans: Office of Inspector General (OIG)
Response Feedback:
Since its 1976 establishment, OIG has been at the forefront of the Nation's
efforts to fight waste, fraud and abuse in Medicare, Medicaid and more than
300 other HHS programs.
According to Inspector General Daniel Levinson, what can help reduce
enforcement on a provider from a CIA to a CCA?
Ans: provider has a robust and effective compliance program
Response Feedback:
Inspector General Daniel Levinson disseminated an Open Letter to
Healthcare Providers in 2006, in which he discussed the current
enforcement and noted that, "many providers have independently developed
robust and effective compliance programs, which include internal auditing
mechanisms. In appropriate cases, we have agreed to reduce the obligation
on providers settling health care fraud matters by entering into Certification
of Compliance Agreements (CCAs), rather than more extensive CIAs.
In addition to hospitals, what other type of facility did the OIG provide
supplemental compliance program guidance for?
Ans: Nursing Facilities
Response Feedback:
Supplemental compliance program guidance was published for nursing
facilities in September 2008.
CPUP was the first large fraud case that involved a teaching hospital where
Residents and Fellows worked and was located in:
