CPCO CERTIFICATION EXAM 2025
QUESTIONS AND ANSWERS
C. Health Care Fraud and Abuse Control Program (HCFAC) -
....ANSWER ...-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. - ....ANSWER ...-According to the
Federal Sentencing Guidelines, "To have an effective compliance and ethics
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
,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. -
....ANSWER ...-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.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
,B. For any services billed, documentation must be present in the patient's medical
record to support the services. - ....ANSWER ...-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. - ....ANSWER ...-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
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 3
, 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.
B. Be sure any timeframes or requirements listed can be accomplished given the
practice's resources. - ....ANSWER ...-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.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 4
QUESTIONS AND ANSWERS
C. Health Care Fraud and Abuse Control Program (HCFAC) -
....ANSWER ...-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. - ....ANSWER ...-According to the
Federal Sentencing Guidelines, "To have an effective compliance and ethics
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
,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. -
....ANSWER ...-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.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
,B. For any services billed, documentation must be present in the patient's medical
record to support the services. - ....ANSWER ...-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. - ....ANSWER ...-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
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 3
, 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.
B. Be sure any timeframes or requirements listed can be accomplished given the
practice's resources. - ....ANSWER ...-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.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 4
