CPCO EXAM QUESTIONS WITH
COMPLETE SOLUTIONS
Question 9
For larger physician practices, how frequently does the OIG recommend reporting
compliance activities to the Board of Directors and CEO? - 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? - 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? -
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? - ANSWER-Well-publicized disciplinary
actions for retaliation
Question 13
What does the HHS OIG suggest as possible warning signs that non-compliance may
exist? - 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? - 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? - 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 and procedures should a billing office have in
place to meet these needs? - ANSWER-Establish and maintain a process for pre- and
post-submission review of claims to ensure claims submitted for reimbursement
accurately represent services provided, are supported by sufficient documentation and
are in conformity with any applicable coverage criteria for reimbursement
Question 17
According to the OIG, medically unnecessary services should only be billed to Medicare
in what circumstance? - ANSWER-To receive a denial so that the claim can be
submitted to a secondary payer.
Question 18
As part of a practice's compliance program, record retention policies and procedures
should be developed. This policy and procedure should address the timeframes
associated with the retention of various records. When developing a policy, which of the
following statements should be present? - ANSWER-Specific records must be retained
based upon the most stringent requirement identified in federal or state law, or internal
policies and procedures
Question 19
A patient being seen by a physician has unpaid medical bills in excess of $5,000 after
insurance payments. The patient has now lost his job and has limited financial
resources. The office manager has reviewed the patient's financial situation to assess
the patient's ability to pay and has agreed to reduce the fees owed to $2,500. Would
this act violate the OIG gift allowance for beneficiaries? - ANSWER-No, this would be
an exception to the OIG gift allowance because it is based on the patient's ability to pay.
Question 20
Services furnished in teaching settings are paid under the Medicare Physician Fee
Schedule (MPFS) if the services are: - ANSWER-Personally furnished by a physician
who is not a resident.
Question 21
Which of the following settings is the incident-to rule not applicable? - ANSWER-
Hospital
Question 22
Assignment is a written agreement between beneficiaries, their physicians or other
suppliers, and Medicare. The beneficiary agrees to let the physician or other suppliers
COMPLETE SOLUTIONS
Question 9
For larger physician practices, how frequently does the OIG recommend reporting
compliance activities to the Board of Directors and CEO? - 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? - 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? -
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? - ANSWER-Well-publicized disciplinary
actions for retaliation
Question 13
What does the HHS OIG suggest as possible warning signs that non-compliance may
exist? - 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? - 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? - 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 and procedures should a billing office have in
place to meet these needs? - ANSWER-Establish and maintain a process for pre- and
post-submission review of claims to ensure claims submitted for reimbursement
accurately represent services provided, are supported by sufficient documentation and
are in conformity with any applicable coverage criteria for reimbursement
Question 17
According to the OIG, medically unnecessary services should only be billed to Medicare
in what circumstance? - ANSWER-To receive a denial so that the claim can be
submitted to a secondary payer.
Question 18
As part of a practice's compliance program, record retention policies and procedures
should be developed. This policy and procedure should address the timeframes
associated with the retention of various records. When developing a policy, which of the
following statements should be present? - ANSWER-Specific records must be retained
based upon the most stringent requirement identified in federal or state law, or internal
policies and procedures
Question 19
A patient being seen by a physician has unpaid medical bills in excess of $5,000 after
insurance payments. The patient has now lost his job and has limited financial
resources. The office manager has reviewed the patient's financial situation to assess
the patient's ability to pay and has agreed to reduce the fees owed to $2,500. Would
this act violate the OIG gift allowance for beneficiaries? - ANSWER-No, this would be
an exception to the OIG gift allowance because it is based on the patient's ability to pay.
Question 20
Services furnished in teaching settings are paid under the Medicare Physician Fee
Schedule (MPFS) if the services are: - ANSWER-Personally furnished by a physician
who is not a resident.
Question 21
Which of the following settings is the incident-to rule not applicable? - ANSWER-
Hospital
Question 22
Assignment is a written agreement between beneficiaries, their physicians or other
suppliers, and Medicare. The beneficiary agrees to let the physician or other suppliers
