CPCO Chapter 11 Review: Exam | Verified Exam Questions and Answers
| Latest Updated Study Material 2026
Question:
Can providers request an extension for providing records requested by an auditor if there is a problem
meeting the deadline?
Answer:
Yes, by calling the requestor and explaining the reason for delay
Question:
Response Feedback
Answer:
Rationale: If there is a problem meeting the deadline, call the requestor to explain the reason for the delay
and ask for an extension.
Question:
What established the Medicaid Integrity Program?
Answer:
Section 1936 of the Social Security Act
Question:
Response Feedback
Answer:
Section 1936 of the Social Security Act created the Medicaid Integrity Program (MIP) and directed the
CMS to enter into contracts to review Medicaid provider actions, audit claims, identify overpayments,
and educate providers and others on Medicaid program integrity issues.
Question:
The Compliance Officer asked the Billing Manager at Orange Hospital how many days they had to send
CERT contractor documentation. The Billing Manager said that documentation had to be sent to the
CERT contractor within
Answer:
5 days
, Question:
Response Feedback
Answer:
75 days. The CERT documentation contractor may request medical records from the provider or supplier
who submitted the claim: For some claim types (e.g., DMEPOS, clinical diagnostic laboratory services),
additional documentation requests are also made to the referring provider who ordered the item or
service. If no documentation is received within 75 days of the initial request, the claim is classified as a
"no documentation" claim and counted as an error. If documentation is received after 75 days of the
initial request (late documentation), CERT will still review the claim.
Question:
What is the jurisdiction limit of Medicaid Fraud Control Units (MFCUs)?
Answer:
Limited to investigating Medicaid provider fraud
Question:
Response Feedback
Answer:
Rationale: The jurisdiction of the Medicaid Fraud Control Units (MFCUs) is limited to investigating and
prosecuting Medicaid provider fraud. The MFCUs have prosecuted individual providers such as
physicians, dentists, and mental health professionals.
Question:
ZPICs target both the of a claim and errors
Answer:
medical necessity, coding
Question:
Response Feedback
Answer:
ZPICs target both the medical necessity of a claim (e.g., whether it was covered according to national or
local coverage determinations and Medicare guidelines) and coding errors (e.g., DRG and E/M services
up-coding). ZPICs are responsible for ensuring the integrity of all Medicare-related claims under Parts A
and B (hospital, skilled nursing, home health, provider and DME claims), Part C (Medicare Advantage
health plans), Part D (prescription drug plans), and coordination with the Medicare-Medicaid Data Match
Program (Medi-Medi).
| Latest Updated Study Material 2026
Question:
Can providers request an extension for providing records requested by an auditor if there is a problem
meeting the deadline?
Answer:
Yes, by calling the requestor and explaining the reason for delay
Question:
Response Feedback
Answer:
Rationale: If there is a problem meeting the deadline, call the requestor to explain the reason for the delay
and ask for an extension.
Question:
What established the Medicaid Integrity Program?
Answer:
Section 1936 of the Social Security Act
Question:
Response Feedback
Answer:
Section 1936 of the Social Security Act created the Medicaid Integrity Program (MIP) and directed the
CMS to enter into contracts to review Medicaid provider actions, audit claims, identify overpayments,
and educate providers and others on Medicaid program integrity issues.
Question:
The Compliance Officer asked the Billing Manager at Orange Hospital how many days they had to send
CERT contractor documentation. The Billing Manager said that documentation had to be sent to the
CERT contractor within
Answer:
5 days
, Question:
Response Feedback
Answer:
75 days. The CERT documentation contractor may request medical records from the provider or supplier
who submitted the claim: For some claim types (e.g., DMEPOS, clinical diagnostic laboratory services),
additional documentation requests are also made to the referring provider who ordered the item or
service. If no documentation is received within 75 days of the initial request, the claim is classified as a
"no documentation" claim and counted as an error. If documentation is received after 75 days of the
initial request (late documentation), CERT will still review the claim.
Question:
What is the jurisdiction limit of Medicaid Fraud Control Units (MFCUs)?
Answer:
Limited to investigating Medicaid provider fraud
Question:
Response Feedback
Answer:
Rationale: The jurisdiction of the Medicaid Fraud Control Units (MFCUs) is limited to investigating and
prosecuting Medicaid provider fraud. The MFCUs have prosecuted individual providers such as
physicians, dentists, and mental health professionals.
Question:
ZPICs target both the of a claim and errors
Answer:
medical necessity, coding
Question:
Response Feedback
Answer:
ZPICs target both the medical necessity of a claim (e.g., whether it was covered according to national or
local coverage determinations and Medicare guidelines) and coding errors (e.g., DRG and E/M services
up-coding). ZPICs are responsible for ensuring the integrity of all Medicare-related claims under Parts A
and B (hospital, skilled nursing, home health, provider and DME claims), Part C (Medicare Advantage
health plans), Part D (prescription drug plans), and coordination with the Medicare-Medicaid Data Match
Program (Medi-Medi).
