CPCO practice test
MICS can audit a medicaid provider throughout their________________ - correct
answer-Country
How many regions make up the Medicaid Fraud control unit? - correct answer-6
Medicaid fraud control units (MFCUs) operate under the direction of _______ - correct
answer-OIG
What records should you submit when a claim is being submitted? - correct answer-Only the
records for the DOS requested
What type of software identifies potential claim errors? - correct answer-Data mining
A compliance officer does not have to be a lawyer, but your chances of implementing a
successful compliance program increases when you are familiar with: - correct
answer-Federal regulations
Which Code of Federal Regulation section is important to Compliance Officers and why? -
correct answer-42, it covers the Medicare and Medicaid programs
Why is the annual OIG Work Plan so important to Compliance Officers when they are
developing their risk assessments? - correct answer-Because it shows the results of
previous years' audit findings and current year focus
Because it is such a large component of their responsibility, what percentage of resources
does OIG dedicate to Medicare and Medicaid? - correct answer-80%
What is one of the main responsibilities of the CMS regional offices? - correct answer-Work
on quality initiatives
Which office would a compliance officer contact if they had a question regarding
discrimination in certain healthcare programs? - correct answer-OCR
What federal agency is charged with the responsibility to ensure safe and healthful working
conditions? - correct answer-OSHA
Where can a compliance officer from a family practice look for information on risks
specifically associated with their practice type? - correct answer-American Academy of
family physicians
What regulation protects the privacy of identifiable health information? - correct
answer-HIPAA
, What type of insurance is required to cover an employees work related injury - correct
answer-Workers compensation
CMS implemented the federally mandated CERT program to establish error rates and
estimates of improper payments in compliance with which law? - correct answer-Improper
payments elimination and recovery improvement Act(IPERIA)
RACs perform what type of review? - correct answer-Automated and complex
ZIPCS - correct answer-Private companies contracted by CMS used to conduct audits for
medicare and medicaid over payments
What sets ZPIC audits apart from other Medicare audits? - correct answer-The audits are
targeted by potential Medicare fraud
What is level 3 of the RAC claims appeals process? - correct answer-Hearing by an
administrative law judge (ALJ)
Advanced beneficiary notice should be presented: - correct answer-When an outpatient
service is not a covered benefit or service of Medicare, patient receives it before the service
is provided
Routine waiver of Medicare deductibles or copayments is a violation of which law - correct
answer-Anti-kickback
Under MSP, the medicare statute and regulations require all entities that bill Medicare for
items or services rendered to Medicare beneficiaries must determine whether - correct
answer-Medicare is the primary payer for those items or services
To ensure that medicare does not incorrectly reimburse the physician for the overhead
portion of the payment if the service was performed in a facility setting, it is important to have
what on the claim? - correct answer-The correct POS
PAR is an acronym for - correct answer-Physicians agree to take assignment on all medicare
claims
Modifier 25 is used to allow additional payment for E/M services performed by a provider on
the same day as a procedure, as long as - correct answer-the E/M services are significant,
separately identifiable, and above and beyond the usual preoperative and postoperative care
associated with the procedure
When billing incident to, the provider does not have to be physically present in the treatment
room while these services are provided, but they must provide - correct answer-direct
supervision and be present in the office suite
Medicare requires physicians and mid-level providers to certify the need for physical,
occupational and speech therapy. The first certification is needed within how many days of
starting therapy? - correct answer-30
MICS can audit a medicaid provider throughout their________________ - correct
answer-Country
How many regions make up the Medicaid Fraud control unit? - correct answer-6
Medicaid fraud control units (MFCUs) operate under the direction of _______ - correct
answer-OIG
What records should you submit when a claim is being submitted? - correct answer-Only the
records for the DOS requested
What type of software identifies potential claim errors? - correct answer-Data mining
A compliance officer does not have to be a lawyer, but your chances of implementing a
successful compliance program increases when you are familiar with: - correct
answer-Federal regulations
Which Code of Federal Regulation section is important to Compliance Officers and why? -
correct answer-42, it covers the Medicare and Medicaid programs
Why is the annual OIG Work Plan so important to Compliance Officers when they are
developing their risk assessments? - correct answer-Because it shows the results of
previous years' audit findings and current year focus
Because it is such a large component of their responsibility, what percentage of resources
does OIG dedicate to Medicare and Medicaid? - correct answer-80%
What is one of the main responsibilities of the CMS regional offices? - correct answer-Work
on quality initiatives
Which office would a compliance officer contact if they had a question regarding
discrimination in certain healthcare programs? - correct answer-OCR
What federal agency is charged with the responsibility to ensure safe and healthful working
conditions? - correct answer-OSHA
Where can a compliance officer from a family practice look for information on risks
specifically associated with their practice type? - correct answer-American Academy of
family physicians
What regulation protects the privacy of identifiable health information? - correct
answer-HIPAA
, What type of insurance is required to cover an employees work related injury - correct
answer-Workers compensation
CMS implemented the federally mandated CERT program to establish error rates and
estimates of improper payments in compliance with which law? - correct answer-Improper
payments elimination and recovery improvement Act(IPERIA)
RACs perform what type of review? - correct answer-Automated and complex
ZIPCS - correct answer-Private companies contracted by CMS used to conduct audits for
medicare and medicaid over payments
What sets ZPIC audits apart from other Medicare audits? - correct answer-The audits are
targeted by potential Medicare fraud
What is level 3 of the RAC claims appeals process? - correct answer-Hearing by an
administrative law judge (ALJ)
Advanced beneficiary notice should be presented: - correct answer-When an outpatient
service is not a covered benefit or service of Medicare, patient receives it before the service
is provided
Routine waiver of Medicare deductibles or copayments is a violation of which law - correct
answer-Anti-kickback
Under MSP, the medicare statute and regulations require all entities that bill Medicare for
items or services rendered to Medicare beneficiaries must determine whether - correct
answer-Medicare is the primary payer for those items or services
To ensure that medicare does not incorrectly reimburse the physician for the overhead
portion of the payment if the service was performed in a facility setting, it is important to have
what on the claim? - correct answer-The correct POS
PAR is an acronym for - correct answer-Physicians agree to take assignment on all medicare
claims
Modifier 25 is used to allow additional payment for E/M services performed by a provider on
the same day as a procedure, as long as - correct answer-the E/M services are significant,
separately identifiable, and above and beyond the usual preoperative and postoperative care
associated with the procedure
When billing incident to, the provider does not have to be physically present in the treatment
room while these services are provided, but they must provide - correct answer-direct
supervision and be present in the office suite
Medicare requires physicians and mid-level providers to certify the need for physical,
occupational and speech therapy. The first certification is needed within how many days of
starting therapy? - correct answer-30
