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Question 1
Under Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996 (HIPAA),
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? ✔Correct Answer-Health Care
Fraud and Abuse Control Program (HCFAC)
Question 2
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: ✔Correct Answer-Promote an organizational culture that
encourages ethical conduct and a commitment to compliance with the law.
Question 3
If a physician practice uses another entity's standards of conduct, the practice must: ✔Correct
Answer-Tailor those materials to the physician practice where they will be applied.
Question 4
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? ✔Correct Answer-For any services billed,
documentation must be present in the patient's medical record to support the services.
Question 5
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? ✔Correct Answer-
Document the conversation and retain the records.
Question 6
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: ✔Correct
Answer-Be sure any time frames or requirements listed can be accomplished given the practice's
resources.
Question 7
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 ____________________. ✔Correct Answer-Verify accuracy of coding and
reimbursement for the services performed.
, Question 8
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? ✔Correct Answer-Reviewing reports to see that new
employees and vendors have been checked against the OIG's list of excluded individuals and entities.
Question 9
For larger physician practices, how frequently does the OIG recommend reporting compliance
activities to the Board of Directors and CEO? ✔Correct Answer-Regularly
Question 10
When conducting compliance training within a physician practice, what is one of the goals that the
practice should strive for in this compliance training? ✔Correct Answer-All employees will receive
training on how to perform their jobs in compliance with the standards of the practice and any
applicable regulations.
Question 11
What is the goal of ongoing auditing and monitoring in a physician's practice? ✔Correct Answer-
Ongoing auditing and monitoring will evaluate whether the physician practice's standards and
procedures are current and accurate and whether the compliance program is working.
Question 12
A compliance program's plan for communication should include a provision for non-retaliation for
reporting fraudulent conduct. Which method below helps ensure that an employee would be free
from retribution? ✔Correct Answer-Well-publicized disciplinary actions for retaliation
Question 13
What does the HHS OIG suggest as possible warning signs that non-compliance may exist?
✔Correct Answer-Significant change in the number or type of claim rejections.
Question 14
Having the ability to respond to issues enables a practice to develop effective action plans to correct
problems and prevent future problems from occurring. What is one step that can be taken to
establish compliance effectiveness for the response/prevention element? ✔Correct Answer-Create
a response team, consisting of representatives from compliance, audit, and any other relevant
functional department.
Question 15
A physician office laboratory is authorized to perform urinalysis testing, including the microscopic
analysis under their PPMP certification. It has been the physician's experience that many of his
patients that have urinalysis testing done also require 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? ✔Correct Answer-Yes. Performing the microscopic test on all patients when the
results of the urinalysis are negative could be considered medically unnecessary.
Question 16
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