CPCO CERTIFICATION EXAM QUESTIONS AND ANSWERS
UPDATED 2024/2025 A COMPLETE SOLUTION WITH 100%
CORRECT VERIFIED ANSWERS BEST GRADED TO SCORE A+ FOR
SUCCESS
A physician office laboratory is authorized to perform urinalysis testing, including the
microscopic analysis under their Provider-Performed Microscopy Procedures (PPMP)
certification. It has been the physician's experience that many of his patients that have
urinalysis testing done also requires the microscopic exam. Because of this and to be able to
provide better treatment, he has established an office policy that for all urinalysis testing
performed in his office, the lab should also perform the microscopic test. Is this a
compliance risk?
A. Yes. Performing the microscopic test on all patients when the results of the urinalysis are
negative could be considered medically unnecessary.
B. Yes. The physician must always order the code for the urinalysis test with the microscopic
exam to avoid unbundling.
C. No. Because the physician is providing quality patient care, there is no compliance risk.
D. No. The physici - CORRECT ANSWERS A. Yes. Performing the microscopic test on all patients
when the results of the urinalysis are negative could be considered medically unnecessary.
Billing companies should have written policies and procedures that reflect and reinforce Federal
and State statutes. These policies must create a mechanism for the billing or reimbursement
staff to communicate effectively and accurately with the health care provider. Which of the
following policies and procedures should a billing office have in place to meet these needs?
A. Conclude that claims may be submitted when note has been started but not yet finalized by
the physician as long as a signed affidavit is in place in the office granting the staff power to
provide coding based on preliminary reports.
B. Provide incentives to billing and coding staff in the form of compensation for productivity to
ensure full revenue recovery of all claims in a timely fashion.
C. Establish and maintain a process for pre- and post-submission review of claims to ensure
claims submitted for reimbursement accurately represent services - CORRECT ANSWERS C.
Establish and maintain a process for pre- and post-submission review of claims to ensure claims
,CPCO CERTIFICATION EXAM QUESTIONS AND ANSWERS
UPDATED 2024/2025 A COMPLETE SOLUTION WITH 100%
CORRECT VERIFIED ANSWERS BEST GRADED TO SCORE A+ FOR
SUCCESS
submitted for reimbursement accurately represent services provided, are supported by
sufficient documentation and are in conformity with any applicable coverage criteria for
reimbursement
According to the OIG, medically unnecessary services should only be billed to Medicare in what
circumstance?
A. When directed to do so by the patient under ABN rules.
B. To receive a denial so that the claim can be submitted to a secondary payer.
C. When the provider is willing to submit the documentation to support the need for the service
even though it is likely that Medicare will deny in any event.
D. They should always be reported provided that an appropriate modifier is used to signal that
the services are not medically necessary and should not be covered. - CORRECT ANSWERS B.
To receive a denial so that the claim can be submitted to a secondary payer.
As part of a practice's compliance program, record retention policies and procedures should be
developed. This policy and procedure should address the timeframes associated with the
retention of various records. When developing a policy, which of the following statements
should be present?
A. Specific records must be retained based upon the most stringent requirement identified in
federal or state law, or internal policies and procedures.
B. Records will be retained based upon federal requirements as this supersedes state law or
internal policies/procedures.
C. Records will be retained based upon state requirements as this supersedes federal law or
internal policies/procedures.
D. Records will be retained based upon internal policies/procedures as this supersedes both
federal and state laws. - CORRECT ANSWERS A. Specific records must be retained based upon
, CPCO CERTIFICATION EXAM QUESTIONS AND ANSWERS
UPDATED 2024/2025 A COMPLETE SOLUTION WITH 100%
CORRECT VERIFIED ANSWERS BEST GRADED TO SCORE A+ FOR
SUCCESS
the most stringent requirement identified in federal or state law, or internal policies and
procedures.
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 - CORRECT ANSWERS 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:
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. - CORRECT ANSWERS 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:
UPDATED 2024/2025 A COMPLETE SOLUTION WITH 100%
CORRECT VERIFIED ANSWERS BEST GRADED TO SCORE A+ FOR
SUCCESS
A physician office laboratory is authorized to perform urinalysis testing, including the
microscopic analysis under their Provider-Performed Microscopy Procedures (PPMP)
certification. It has been the physician's experience that many of his patients that have
urinalysis testing done also requires the microscopic exam. Because of this and to be able to
provide better treatment, he has established an office policy that for all urinalysis testing
performed in his office, the lab should also perform the microscopic test. Is this a
compliance risk?
A. Yes. Performing the microscopic test on all patients when the results of the urinalysis are
negative could be considered medically unnecessary.
B. Yes. The physician must always order the code for the urinalysis test with the microscopic
exam to avoid unbundling.
C. No. Because the physician is providing quality patient care, there is no compliance risk.
D. No. The physici - CORRECT ANSWERS A. Yes. Performing the microscopic test on all patients
when the results of the urinalysis are negative could be considered medically unnecessary.
Billing companies should have written policies and procedures that reflect and reinforce Federal
and State statutes. These policies must create a mechanism for the billing or reimbursement
staff to communicate effectively and accurately with the health care provider. Which of the
following policies and procedures should a billing office have in place to meet these needs?
A. Conclude that claims may be submitted when note has been started but not yet finalized by
the physician as long as a signed affidavit is in place in the office granting the staff power to
provide coding based on preliminary reports.
B. Provide incentives to billing and coding staff in the form of compensation for productivity to
ensure full revenue recovery of all claims in a timely fashion.
C. Establish and maintain a process for pre- and post-submission review of claims to ensure
claims submitted for reimbursement accurately represent services - CORRECT ANSWERS C.
Establish and maintain a process for pre- and post-submission review of claims to ensure claims
,CPCO CERTIFICATION EXAM QUESTIONS AND ANSWERS
UPDATED 2024/2025 A COMPLETE SOLUTION WITH 100%
CORRECT VERIFIED ANSWERS BEST GRADED TO SCORE A+ FOR
SUCCESS
submitted for reimbursement accurately represent services provided, are supported by
sufficient documentation and are in conformity with any applicable coverage criteria for
reimbursement
According to the OIG, medically unnecessary services should only be billed to Medicare in what
circumstance?
A. When directed to do so by the patient under ABN rules.
B. To receive a denial so that the claim can be submitted to a secondary payer.
C. When the provider is willing to submit the documentation to support the need for the service
even though it is likely that Medicare will deny in any event.
D. They should always be reported provided that an appropriate modifier is used to signal that
the services are not medically necessary and should not be covered. - CORRECT ANSWERS B.
To receive a denial so that the claim can be submitted to a secondary payer.
As part of a practice's compliance program, record retention policies and procedures should be
developed. This policy and procedure should address the timeframes associated with the
retention of various records. When developing a policy, which of the following statements
should be present?
A. Specific records must be retained based upon the most stringent requirement identified in
federal or state law, or internal policies and procedures.
B. Records will be retained based upon federal requirements as this supersedes state law or
internal policies/procedures.
C. Records will be retained based upon state requirements as this supersedes federal law or
internal policies/procedures.
D. Records will be retained based upon internal policies/procedures as this supersedes both
federal and state laws. - CORRECT ANSWERS A. Specific records must be retained based upon
, CPCO CERTIFICATION EXAM QUESTIONS AND ANSWERS
UPDATED 2024/2025 A COMPLETE SOLUTION WITH 100%
CORRECT VERIFIED ANSWERS BEST GRADED TO SCORE A+ FOR
SUCCESS
the most stringent requirement identified in federal or state law, or internal policies and
procedures.
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 - CORRECT ANSWERS 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:
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. - CORRECT ANSWERS 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:
