CPCO EXAM QUESTIONS With Complete Solutions!!

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? -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: -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: -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? -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? -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: -ANSWER Be sure any time frames or requirements listed can be accomplished given the practice's resources.