CPCO Exam Questions With 100%
Correct Answers
For larger physician practices, how often does the OIG suggest reporting compliance
activities to the board of directors? - Answer Regularly
According to the OIG, medically unnecessary services can be billed to Medicare for
what purpose? - Answer To receive a denial so a claim can be submitted to a
secondary payer.
Which component of the OIG has a duty of operating the OIG hotline? - Answer Office
of Investigations
What year did the GAO identify Medicare claims to be at high risk for fraud and abuse
which resulted in the OIG initiating an audit of HCFA (CMS) payment system? - Answer
1992
Which department of the OIG is responsible for providing mission and administrative
support to the OIG? - Answer Office of Management and Policy
Which component of the OIG has a duty of conducting audits, which results in reducing
waste, abuse and mismanagement? - Answer Office of Audit Services
According to Inspector General Daniel Levinson, what can help reduce enforcement on
a provider from a CIA to a CCA? - Answer Have a robust and effective compliance
program
A majority of the OIG's resources goes to oversight of which programs? - Answer
Medicare and Medicaid
What year was the Patient Protection and Affordable Care Act (PPACA) enacted? -
Answer 2010
What does the acronym LEP stand for? - Answer Limited English Proficiency
Everyone should be educated in their role in adhering to the Compliance Program
including their duty to report . - Answer Suspected misconduct
Employees have to report erroneous conduct, without repercussion, so
that it may be corrected immediately. - Answer A duty
,Records associated with an inquiry will include the nature of the inquiry or report, the
investigation procedures and outcomes, and all actions taken by the Compliance Officer
and/or the organization to rectify any non-compliance uncovered. What is an important
component of the compliance officers responsibility when managing incidents and
investigations? - Answer Board of Directors need to be kept apprised of ongoing
investigations and results.
The is when an organization offers another organization an incentive
referrals. - Answer Improper inducements.
The risk assessment is an essential component of the compliance officer's
responsibilities. Once risks have been identified and prioritized, the next step in the
process is to ? - Answer Conduct audits based on the risk assessment
findings
When conducting a risk assessment, one of the most important and key sources of
information that a compliance office should utilize is . - Answer Office of
Inspector General's Annual Audit Plan
One of the most important elements of an effective compliance program is to have a
compliance officer or committee who is . - Answer Empowered.
The mission statement of the healthcare organization and a statement of why they are
in business are also know as ? - Answer The code of conduct.
The compliance officer will report directly to - Answer The managing physicians and
board
How many components are required by the OIG to have an effective Compliance
Program? - Answer 7
What will show a third party's good faith toward remediation? - Answer Compliance
Program
What is the Federal agency that provides compliance program guidance to providers
and covered entities? - Answer Office of Inspector General
A clinical laboratory gets all of their Medicare patients to sign a blank ABN in case
Medicare does not pay for a service. This is part of the clinic's written policy, therefore is
in compliance Y/N - Answer No, laboratory may never ask a patient to sign a blank ABN
Can the government take back monies from a nursing facility for failure of a patient's
care? - Answer Yes, there is a direct link to quality of care and billing for services.
,Clinical Laboratories should charge physicians a price for ordered tests at
- Answer Fair Market Value
Every third party health care company should designate someone to serve as the focal
point for compliance activities. This position is called a . - Answer
Compliance Coordinator.
What can result in imprisonment and penalties for providers and covered entities? -
Answer Medical fraud
Does Medicare pay for all tests ordered by Providers? - Answer No, they need to
determine if it's covered and medically necessary.
What two laws relate primarily to the relationships between referral sources, such as
physicians and hospitals? - Answer Anti-kickback and Stark Laws.
If physician recruitment arrangements are not properly structured, it can result in
- Answer EMTALA violations
Penalties under the FCA include how much - Answer Treble damages, plus a penalty of
$5500 to $11,000 for each false claim filed.
What should you do when you find out one of your employees has been excluded from
government programs? - Answer Suspend the employee, request documentation, and
investigate the matter.
Some joint ventures may violate the Medicare and Medicaid .-
Answer Anti-kickback statute
The Office of Civil Rights (OCR) has enforcement power for violations occurring as a
result of willful neglect. OCR can now impose civil monetary penalties of up to how
much per HIPAA privacy regulations violation. - Answer $50,000
Physicians sometimes own other health-related businesses, such as physical therapy
facilities, CME or home health companies, diagnostic imaging centers, or laboratories.
Because these businesses provide designated health services, what may be triggered?
- Answer Stark
Which law increases the severity of penalties for violations involving organized crime? -
Answer RICO Act
Which law provides for a civil monetary penalty (up to $15,000 per service) and
exclusion from government programs in any case where a person submits an improper
claim, which was know to have been, or should have been know to have been, provided
through a prohibited referral, and has not refunded the payment? - Answer Stark
, Which of these responsibilities is not one of a compliance officer? - Answer Create all
policies and procedures
What are key responsibilities of a compliance officer? - Answer Ensure internal controls
are capable of preventing and detecting significant instances or patterns of illegal,
unethical or improper conduct.
Monitor the performance of the practice's compliance program on an ongoing basis and
take steps to improve effectiveness.
Identify and assess areas of compliance risk.
What year did HITECH Act get implemented? - Answer 2009
What policy is important in dealing with employee concerns? - Answer Non-Retaliation
policy
When can a covered entity disclose PHI without a patient's consent? - Answer When
providing in cases of suspected abuse.
What covered entity as the most HIPAA breaches? - Answer Business Associates
How soon are practices or medical organizations required to process record requests? -
Answer Within 30 days
What does HITECH stand for? - Answer Health Information Technology for Economic
and Clinical Health
What safeguard is defined as measures to protect electronic systems? - Answer
Physical safeguards
What does the term "Disclosure" mean? - Answer The release or transfer of information
to an outside entity
Alerts for Physician's office labs from Medicare on expired certificate will cause your
Medicare carrier to - Answer Deny claims
If a person presents to the emergency department and collapses outside the ER doors,
is EMTLA evoked? - Answer Yes, the 250 yard zone applies in this case.
CLIA is funded by whom? - Answer Users
A person having an asthma attach presented to the physician office on the hospital
campus. The office did not have a provider in the office and the patient had to go to the
Emergency department around the corner for treatment. Is the physician office in
violation of EMTALA? - Answer No, EMTALA does not include physician practices.
Correct Answers
For larger physician practices, how often does the OIG suggest reporting compliance
activities to the board of directors? - Answer Regularly
According to the OIG, medically unnecessary services can be billed to Medicare for
what purpose? - Answer To receive a denial so a claim can be submitted to a
secondary payer.
Which component of the OIG has a duty of operating the OIG hotline? - Answer Office
of Investigations
What year did the GAO identify Medicare claims to be at high risk for fraud and abuse
which resulted in the OIG initiating an audit of HCFA (CMS) payment system? - Answer
1992
Which department of the OIG is responsible for providing mission and administrative
support to the OIG? - Answer Office of Management and Policy
Which component of the OIG has a duty of conducting audits, which results in reducing
waste, abuse and mismanagement? - Answer Office of Audit Services
According to Inspector General Daniel Levinson, what can help reduce enforcement on
a provider from a CIA to a CCA? - Answer Have a robust and effective compliance
program
A majority of the OIG's resources goes to oversight of which programs? - Answer
Medicare and Medicaid
What year was the Patient Protection and Affordable Care Act (PPACA) enacted? -
Answer 2010
What does the acronym LEP stand for? - Answer Limited English Proficiency
Everyone should be educated in their role in adhering to the Compliance Program
including their duty to report . - Answer Suspected misconduct
Employees have to report erroneous conduct, without repercussion, so
that it may be corrected immediately. - Answer A duty
,Records associated with an inquiry will include the nature of the inquiry or report, the
investigation procedures and outcomes, and all actions taken by the Compliance Officer
and/or the organization to rectify any non-compliance uncovered. What is an important
component of the compliance officers responsibility when managing incidents and
investigations? - Answer Board of Directors need to be kept apprised of ongoing
investigations and results.
The is when an organization offers another organization an incentive
referrals. - Answer Improper inducements.
The risk assessment is an essential component of the compliance officer's
responsibilities. Once risks have been identified and prioritized, the next step in the
process is to ? - Answer Conduct audits based on the risk assessment
findings
When conducting a risk assessment, one of the most important and key sources of
information that a compliance office should utilize is . - Answer Office of
Inspector General's Annual Audit Plan
One of the most important elements of an effective compliance program is to have a
compliance officer or committee who is . - Answer Empowered.
The mission statement of the healthcare organization and a statement of why they are
in business are also know as ? - Answer The code of conduct.
The compliance officer will report directly to - Answer The managing physicians and
board
How many components are required by the OIG to have an effective Compliance
Program? - Answer 7
What will show a third party's good faith toward remediation? - Answer Compliance
Program
What is the Federal agency that provides compliance program guidance to providers
and covered entities? - Answer Office of Inspector General
A clinical laboratory gets all of their Medicare patients to sign a blank ABN in case
Medicare does not pay for a service. This is part of the clinic's written policy, therefore is
in compliance Y/N - Answer No, laboratory may never ask a patient to sign a blank ABN
Can the government take back monies from a nursing facility for failure of a patient's
care? - Answer Yes, there is a direct link to quality of care and billing for services.
,Clinical Laboratories should charge physicians a price for ordered tests at
- Answer Fair Market Value
Every third party health care company should designate someone to serve as the focal
point for compliance activities. This position is called a . - Answer
Compliance Coordinator.
What can result in imprisonment and penalties for providers and covered entities? -
Answer Medical fraud
Does Medicare pay for all tests ordered by Providers? - Answer No, they need to
determine if it's covered and medically necessary.
What two laws relate primarily to the relationships between referral sources, such as
physicians and hospitals? - Answer Anti-kickback and Stark Laws.
If physician recruitment arrangements are not properly structured, it can result in
- Answer EMTALA violations
Penalties under the FCA include how much - Answer Treble damages, plus a penalty of
$5500 to $11,000 for each false claim filed.
What should you do when you find out one of your employees has been excluded from
government programs? - Answer Suspend the employee, request documentation, and
investigate the matter.
Some joint ventures may violate the Medicare and Medicaid .-
Answer Anti-kickback statute
The Office of Civil Rights (OCR) has enforcement power for violations occurring as a
result of willful neglect. OCR can now impose civil monetary penalties of up to how
much per HIPAA privacy regulations violation. - Answer $50,000
Physicians sometimes own other health-related businesses, such as physical therapy
facilities, CME or home health companies, diagnostic imaging centers, or laboratories.
Because these businesses provide designated health services, what may be triggered?
- Answer Stark
Which law increases the severity of penalties for violations involving organized crime? -
Answer RICO Act
Which law provides for a civil monetary penalty (up to $15,000 per service) and
exclusion from government programs in any case where a person submits an improper
claim, which was know to have been, or should have been know to have been, provided
through a prohibited referral, and has not refunded the payment? - Answer Stark
, Which of these responsibilities is not one of a compliance officer? - Answer Create all
policies and procedures
What are key responsibilities of a compliance officer? - Answer Ensure internal controls
are capable of preventing and detecting significant instances or patterns of illegal,
unethical or improper conduct.
Monitor the performance of the practice's compliance program on an ongoing basis and
take steps to improve effectiveness.
Identify and assess areas of compliance risk.
What year did HITECH Act get implemented? - Answer 2009
What policy is important in dealing with employee concerns? - Answer Non-Retaliation
policy
When can a covered entity disclose PHI without a patient's consent? - Answer When
providing in cases of suspected abuse.
What covered entity as the most HIPAA breaches? - Answer Business Associates
How soon are practices or medical organizations required to process record requests? -
Answer Within 30 days
What does HITECH stand for? - Answer Health Information Technology for Economic
and Clinical Health
What safeguard is defined as measures to protect electronic systems? - Answer
Physical safeguards
What does the term "Disclosure" mean? - Answer The release or transfer of information
to an outside entity
Alerts for Physician's office labs from Medicare on expired certificate will cause your
Medicare carrier to - Answer Deny claims
If a person presents to the emergency department and collapses outside the ER doors,
is EMTLA evoked? - Answer Yes, the 250 yard zone applies in this case.
CLIA is funded by whom? - Answer Users
A person having an asthma attach presented to the physician office on the hospital
campus. The office did not have a provider in the office and the patient had to go to the
Emergency department around the corner for treatment. Is the physician office in
violation of EMTALA? - Answer No, EMTALA does not include physician practices.
