CPCO Certification Exam | Verified Exam Questions and Answers |
Latest Updated Study Material 2026
Question:
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191,
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:
Question:
A. Health Care Fraud Prevention and Enforcement Action Team (HEAT) B. Health Care Recovery and
Affordable Care Act (HCRAC) C. Health Care Fraud and Abuse Control Program (HCFAC) D. Health
Care Civil Penalties Law
Answer:
C. Health Care Fraud and Abuse Control Program (HCFAC) 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:
Question:
A. Promote an organizational culture that encourages ethical conduct and a commitment to compliance
with the law. B. Implement mandatory compliance programs. C. Perform annual audits to detect criminal
conduct. D. Immediately report evidence of misconduct to the authorities.
Answer:
A. Promote an organizational culture that encourages ethical conduct and a commitment to compliance
with the law. If a physician practice uses another entity's standards of conduct, the practice must:
Question:
A. Implement the standards of conduct as received because they have already been approved. B. Tailor
those materials to the physician practice where they will be applied. C. Only select those standards that
represent high risk issues for the practice. D. None of the above. Physician practices must create their
own standards of conduct. It would be a compliance violation to copy another entity's standards of
conduct.
Answer:
B. Tailor those materials to the physician practice where they will be applied.
,Question:
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:
Question:
A. If a new physician joins the practice and the new physician's NPI has not been received, services
performed should be reported using the practice medical director's NPI. B. For any services billed,
documentation must be present in the patient's medical record to support the services. C. To avoid
compliance risk, coding for E/M services should be based solely on medical record documentation, even
if it appears the level of service is not warranted. D. For denied services, billing staff should notify the
physician to change the reported diagnosis to allow for resubmission and payment of the claim.
Answer:
B. For any services billed, documentation must be present in the patient's medical record to support the
services.
Question:
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:
Question:
A. Call someone else at the Medicare Administrative Contractor to confirm the information received. B.
Send a letter to CMS to confirm the information provided by the Medicare Administrative Contractor is
correct. C. Both A and B D. Document the conversation and retain th
Answer:
D. Document the conversation and retain the records. 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: A. Only be one page long to promote understanding by all staff. B.
Be sure any timeframes or requirements listed can be accomplished given the practice's resources.
, Question:
C. Be written by consultants because they are more familiar with the variety of healthcare regulations
that apply to the practice. D. Both B and C
Answer:
B. Be sure any timeframes or requirements listed can be accomplished given the practice's resources.
Question:
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 .
Answer:
Question:
A. Maximize reimbursement for the services performed. B. Optimize reimbursement for the services
performed. C. Verify accuracy of coding and reimbursement for the services performed. D. Ensure all
services are submitted for reimbursement.
Answer:
C. Verify accuracy of coding and reimbursement for the services performed.
Question:
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?
Answer:
Question:
A. Reviewing reports to see that new employees and vendors have been checked against the OIG's list of
excluded individuals and entities. B. Making sure no one changes the compliance program so you are
able to show how the program was implemented. C. Reviewing all claims being submitted to be sure they
do not violate fraud and abuse laws. D. Submitting annual reports to the Office of Inspector General on
all compliance activities undertaken during the year.
Answer:
A. Reviewing reports to see that new employees and vendors have been checked against the OIG's list of
excluded individuals and entities.
Latest Updated Study Material 2026
Question:
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191,
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:
Question:
A. Health Care Fraud Prevention and Enforcement Action Team (HEAT) B. Health Care Recovery and
Affordable Care Act (HCRAC) C. Health Care Fraud and Abuse Control Program (HCFAC) D. Health
Care Civil Penalties Law
Answer:
C. Health Care Fraud and Abuse Control Program (HCFAC) 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:
Question:
A. Promote an organizational culture that encourages ethical conduct and a commitment to compliance
with the law. B. Implement mandatory compliance programs. C. Perform annual audits to detect criminal
conduct. D. Immediately report evidence of misconduct to the authorities.
Answer:
A. Promote an organizational culture that encourages ethical conduct and a commitment to compliance
with the law. If a physician practice uses another entity's standards of conduct, the practice must:
Question:
A. Implement the standards of conduct as received because they have already been approved. B. Tailor
those materials to the physician practice where they will be applied. C. Only select those standards that
represent high risk issues for the practice. D. None of the above. Physician practices must create their
own standards of conduct. It would be a compliance violation to copy another entity's standards of
conduct.
Answer:
B. Tailor those materials to the physician practice where they will be applied.
,Question:
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:
Question:
A. If a new physician joins the practice and the new physician's NPI has not been received, services
performed should be reported using the practice medical director's NPI. B. For any services billed,
documentation must be present in the patient's medical record to support the services. C. To avoid
compliance risk, coding for E/M services should be based solely on medical record documentation, even
if it appears the level of service is not warranted. D. For denied services, billing staff should notify the
physician to change the reported diagnosis to allow for resubmission and payment of the claim.
Answer:
B. For any services billed, documentation must be present in the patient's medical record to support the
services.
Question:
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:
Question:
A. Call someone else at the Medicare Administrative Contractor to confirm the information received. B.
Send a letter to CMS to confirm the information provided by the Medicare Administrative Contractor is
correct. C. Both A and B D. Document the conversation and retain th
Answer:
D. Document the conversation and retain the records. 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: A. Only be one page long to promote understanding by all staff. B.
Be sure any timeframes or requirements listed can be accomplished given the practice's resources.
, Question:
C. Be written by consultants because they are more familiar with the variety of healthcare regulations
that apply to the practice. D. Both B and C
Answer:
B. Be sure any timeframes or requirements listed can be accomplished given the practice's resources.
Question:
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 .
Answer:
Question:
A. Maximize reimbursement for the services performed. B. Optimize reimbursement for the services
performed. C. Verify accuracy of coding and reimbursement for the services performed. D. Ensure all
services are submitted for reimbursement.
Answer:
C. Verify accuracy of coding and reimbursement for the services performed.
Question:
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?
Answer:
Question:
A. Reviewing reports to see that new employees and vendors have been checked against the OIG's list of
excluded individuals and entities. B. Making sure no one changes the compliance program so you are
able to show how the program was implemented. C. Reviewing all claims being submitted to be sure they
do not violate fraud and abuse laws. D. Submitting annual reports to the Office of Inspector General on
all compliance activities undertaken during the year.
Answer:
A. Reviewing reports to see that new employees and vendors have been checked against the OIG's list of
excluded individuals and entities.
