CPCO Certification Exam | Questions and Answers with complete solution

Health Care Fraud and Abuse Control Program (HCFAC) - 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? 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 A. Promote an organizational culture that encourages ethical conduct and a commitment to compliance with the law. - 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: 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. B. Tailor those materials to the physician practice where they will be applied. - If a physician practice uses another entity's standards of conduct, the practice must: 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. B. For any services billed, documentation must be present in the patient's medical record to support the services. - 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? 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. D. Document the conversation and retain the records. - 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? 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 the records