CPCO CHAPTER #12 EXAM QUESTIONS
WITH CORRECT ANSWERS
Which Code of Federal Regulation section is important to Compliance Officers and
why?
42; it covers the Medicare and Medicaid programs
42; it covers practice management rules
40; it covers military insurance issues
40; it covers HIPAA privacy rules - ANSWER-42; it covers the Medicare and Medicaid
programs
The bulk of the federal regulations in 42 CFR Part 4 covers the Medicare and Medicaid
programs.
The guidance provided by the OIG can be incorporated in policies to prevent
_______________________________ errors from occurring.
documentation and coding
coding and auditing
coding and billing
billing and fee schedule - ANSWER-coding and billing
The guidance provided by the OIG can be incorporated in policies to prevent coding and
billing errors form occurring and help with false claims.
Incident-to services are defined as those services that are furnished incident to
physician professional services in the physician's office (whether located in a separate
office suite or within an institution) or in a patient's home. Who may provide incident-to
services?
fellow
non-physician provider (NP or PA)
resident
All of the above - ANSWER-non-physician provider (NP or PA)
Incident-to services are defined as those services that are furnished incident to
physician professional services in the physician's office (whether located in a separate
office suite or within an institution) or in a patient's home. The overseeing provider does
not have to be physically present in the same room while the services are provided but
must provide direct supervision. If it is physician's group, any physician member of the
group may be present in the office to supervise. There have been some questions
recently about whether a Non-Physician Provider (NP or PA) could see patients in the
hospital or a Skilled Nursing Facility (SNF) and bill incident-to.
Workers Compensation is part of the _________.
DOL
OIG
CMS
DOJ - ANSWER-DOL
, Workers Compensation is part of the Department of Labor.
Which entity enforces the HIPAA Privacy Rule?
OIG
DOJ
HHS
OCR - ANSWER-OCR
The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy
of individually identifiable health information; the HIPAA Security Rule, which sets
national standards for the security of ePHI; the HIPAA Breach Notification Rule, which
requires covered entities and business associates to provide notification following a
breach of unsecured PHI; and the confidentiality provisions of the Patient Safety Rule,
which protect identifiable information being used to analyze patient safety events and
improve patient safety. OCR also provides oversight of the HIPAA Enforcement Rule.
CMS publishes the physician fee schedule each year in the _____.
Federal Register
Work Plan
Semi Annual Report
Advisory Letters - ANSWER-Federal Register
CMS publishes the physician fee schedule each year in the Federal Register.
Advance Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131. This section
provides instructions regarding the notice issued by providers to beneficiaries in
advance of providing what they believe to be ________ services.
covered
deductible
non-covered
medically necessary - ANSWER-non-covered
Section 50 of the Medicare Claims Processing Manual establishes the standards for use
by providers and suppliers (including laboratories) in implementing the Advance
Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131. This section provides
instructions regarding the notice issued by providers to beneficiaries in advance of
providing what they believe to be non-covered items or services.
Which statement is TRUE regarding marketing providers who are credentialed with
Medicare?
A provider can market as approved by Medicare within a 100 mile radius of his practice.
A provider can market himself as credentialed or approved as the terms are used
interchangeable.
Marketing a provider as credentialed is only allowed once the provider has been
contracted with Medicare for more than one year.
Marketing a provider as approved by Medicare is a violation of the Social Security Act. -
ANSWER-Marketing a provider as approved by Medicare is a violation of the Social
Security Act.
WITH CORRECT ANSWERS
Which Code of Federal Regulation section is important to Compliance Officers and
why?
42; it covers the Medicare and Medicaid programs
42; it covers practice management rules
40; it covers military insurance issues
40; it covers HIPAA privacy rules - ANSWER-42; it covers the Medicare and Medicaid
programs
The bulk of the federal regulations in 42 CFR Part 4 covers the Medicare and Medicaid
programs.
The guidance provided by the OIG can be incorporated in policies to prevent
_______________________________ errors from occurring.
documentation and coding
coding and auditing
coding and billing
billing and fee schedule - ANSWER-coding and billing
The guidance provided by the OIG can be incorporated in policies to prevent coding and
billing errors form occurring and help with false claims.
Incident-to services are defined as those services that are furnished incident to
physician professional services in the physician's office (whether located in a separate
office suite or within an institution) or in a patient's home. Who may provide incident-to
services?
fellow
non-physician provider (NP or PA)
resident
All of the above - ANSWER-non-physician provider (NP or PA)
Incident-to services are defined as those services that are furnished incident to
physician professional services in the physician's office (whether located in a separate
office suite or within an institution) or in a patient's home. The overseeing provider does
not have to be physically present in the same room while the services are provided but
must provide direct supervision. If it is physician's group, any physician member of the
group may be present in the office to supervise. There have been some questions
recently about whether a Non-Physician Provider (NP or PA) could see patients in the
hospital or a Skilled Nursing Facility (SNF) and bill incident-to.
Workers Compensation is part of the _________.
DOL
OIG
CMS
DOJ - ANSWER-DOL
, Workers Compensation is part of the Department of Labor.
Which entity enforces the HIPAA Privacy Rule?
OIG
DOJ
HHS
OCR - ANSWER-OCR
The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy
of individually identifiable health information; the HIPAA Security Rule, which sets
national standards for the security of ePHI; the HIPAA Breach Notification Rule, which
requires covered entities and business associates to provide notification following a
breach of unsecured PHI; and the confidentiality provisions of the Patient Safety Rule,
which protect identifiable information being used to analyze patient safety events and
improve patient safety. OCR also provides oversight of the HIPAA Enforcement Rule.
CMS publishes the physician fee schedule each year in the _____.
Federal Register
Work Plan
Semi Annual Report
Advisory Letters - ANSWER-Federal Register
CMS publishes the physician fee schedule each year in the Federal Register.
Advance Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131. This section
provides instructions regarding the notice issued by providers to beneficiaries in
advance of providing what they believe to be ________ services.
covered
deductible
non-covered
medically necessary - ANSWER-non-covered
Section 50 of the Medicare Claims Processing Manual establishes the standards for use
by providers and suppliers (including laboratories) in implementing the Advance
Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131. This section provides
instructions regarding the notice issued by providers to beneficiaries in advance of
providing what they believe to be non-covered items or services.
Which statement is TRUE regarding marketing providers who are credentialed with
Medicare?
A provider can market as approved by Medicare within a 100 mile radius of his practice.
A provider can market himself as credentialed or approved as the terms are used
interchangeable.
Marketing a provider as credentialed is only allowed once the provider has been
contracted with Medicare for more than one year.
Marketing a provider as approved by Medicare is a violation of the Social Security Act. -
ANSWER-Marketing a provider as approved by Medicare is a violation of the Social
Security Act.
