CPCO Chapter 3 Review
When a compliance program is established, the OIG recommends that a billing company,
takes a ___________________ of the Company's operations. - correct answer-Snapshot
Response Feedback:
Rationale: The snapshot will let the company know where the organization is with their
compliance and what their risk areas are.
There has been an increased national focus on ____________. - correct answer-Quality of
health care
Response Feedback:
The trend away from a departmental focus and toward "patient-focused" care in hospitals
and physician practices has been emerging. There is currently a national focus on the quality
of care a patient receives while being treated.
The _______________addresses compliance concerns, such as compensation paid by
laboratories to referring physicians and physician group practices for blood specimen
collection, processing and packaging and for submitting patient data to registry or database.
- correct answer-Special Fraud Alert
Response Feedback:
The OIG has designed and issued special fraud alerts to the health care provider community
for the last 20 years.
Joan is the CO for ABC Provider Group. One of her providers asks her which Federal
agency provides compliance program guidance to providers and covered entities? Joan tells
the provider: - correct answer-Office of Inspector General
Response Feedback:
The OIG has been providing compliance program guidelines since 1998.
Federal regulations pertinent to billing companies include all except: - correct answer-Safe
Harbor Rules for Billing Companies
Response Feedback:
The "safe harbor" regulations describe various payment and business practices that,
although they potentially implicate the Federal anti-kickback statute, are not treated as
offenses under the statute.
Laura is the CPCO for Angel Nursing home. She is explaining to the staff why is it important
for nursing facilities to track patient outcomes. She states this is to: - correct
answer-accomplish compliance
Response Feedback:
, Nursing Facilities can accomplish compliance through development of protocols and through
a system that reviews and analyzes each patient's/resident's outcomes with the protocols.
The OlG Work Plan includes projects to be addressed during the fiscal year (and beyond) by
the all of the following EXCEPT: - correct answer-Office of HHS
Response Feedback:
The OIG Work Plan includes projects to be addressed during the fiscal year (and beyond) by
the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations,
and Office of Counsel to the Inspector General. The entire current Work Plan or sections of
the plan can be downloaded at the OIG's website at
https://oig.hhs.gov/reports-and-publications/workplan/.
What can result in imprisonment and penalties for providers and covered entities? - correct
answer-Medical fraud
Response Feedback:
Medical fraud is a federal crime that is costly and, when committed, can result in financial
penalties and jail time. The difference between fraud and abuse is "intent."
Anti-dumping statues, 42 U.S.C. 1395dd, require a hospital to do all of the following
EXCEPT? - correct answer-Transfer to another hospital if emergency room is busy
Response Feedback:
The statute requires all hospitals that participate with Medicare follow the patient dumping
rules. There are strict rules about what must be done before a patient can be transferred.
What will show a third party that they have good faith towards remediation? - correct
answer-Prompt reporting
Response Feedback:
By promptly reporting any wrongdoings a third party shows good faith and willingness to
work with governmental authorities to correct and remedy the problem.
Kim is the CPCO at Apple Hospital. A provider asks her, if Medicare pays for all tests
ordered by providers? What should be her response? - correct answer-No, they need to
determine if it's covered and medically necessary
Response Feedback:
Physicians can order any tests they believe are appropriate; however, Medicare will only pay
for those tests which are covered, reasonable and medically necessary.
Providers need to have a(n) ________________signed by the patient prior to services if they
believe that Medicare will not cover the services. - correct answer-ABN form
Response Feedback:
An ABN must always be signed prior to the services being done
When a compliance program is established, the OIG recommends that a billing company,
takes a ___________________ of the Company's operations. - correct answer-Snapshot
Response Feedback:
Rationale: The snapshot will let the company know where the organization is with their
compliance and what their risk areas are.
There has been an increased national focus on ____________. - correct answer-Quality of
health care
Response Feedback:
The trend away from a departmental focus and toward "patient-focused" care in hospitals
and physician practices has been emerging. There is currently a national focus on the quality
of care a patient receives while being treated.
The _______________addresses compliance concerns, such as compensation paid by
laboratories to referring physicians and physician group practices for blood specimen
collection, processing and packaging and for submitting patient data to registry or database.
- correct answer-Special Fraud Alert
Response Feedback:
The OIG has designed and issued special fraud alerts to the health care provider community
for the last 20 years.
Joan is the CO for ABC Provider Group. One of her providers asks her which Federal
agency provides compliance program guidance to providers and covered entities? Joan tells
the provider: - correct answer-Office of Inspector General
Response Feedback:
The OIG has been providing compliance program guidelines since 1998.
Federal regulations pertinent to billing companies include all except: - correct answer-Safe
Harbor Rules for Billing Companies
Response Feedback:
The "safe harbor" regulations describe various payment and business practices that,
although they potentially implicate the Federal anti-kickback statute, are not treated as
offenses under the statute.
Laura is the CPCO for Angel Nursing home. She is explaining to the staff why is it important
for nursing facilities to track patient outcomes. She states this is to: - correct
answer-accomplish compliance
Response Feedback:
, Nursing Facilities can accomplish compliance through development of protocols and through
a system that reviews and analyzes each patient's/resident's outcomes with the protocols.
The OlG Work Plan includes projects to be addressed during the fiscal year (and beyond) by
the all of the following EXCEPT: - correct answer-Office of HHS
Response Feedback:
The OIG Work Plan includes projects to be addressed during the fiscal year (and beyond) by
the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations,
and Office of Counsel to the Inspector General. The entire current Work Plan or sections of
the plan can be downloaded at the OIG's website at
https://oig.hhs.gov/reports-and-publications/workplan/.
What can result in imprisonment and penalties for providers and covered entities? - correct
answer-Medical fraud
Response Feedback:
Medical fraud is a federal crime that is costly and, when committed, can result in financial
penalties and jail time. The difference between fraud and abuse is "intent."
Anti-dumping statues, 42 U.S.C. 1395dd, require a hospital to do all of the following
EXCEPT? - correct answer-Transfer to another hospital if emergency room is busy
Response Feedback:
The statute requires all hospitals that participate with Medicare follow the patient dumping
rules. There are strict rules about what must be done before a patient can be transferred.
What will show a third party that they have good faith towards remediation? - correct
answer-Prompt reporting
Response Feedback:
By promptly reporting any wrongdoings a third party shows good faith and willingness to
work with governmental authorities to correct and remedy the problem.
Kim is the CPCO at Apple Hospital. A provider asks her, if Medicare pays for all tests
ordered by providers? What should be her response? - correct answer-No, they need to
determine if it's covered and medically necessary
Response Feedback:
Physicians can order any tests they believe are appropriate; however, Medicare will only pay
for those tests which are covered, reasonable and medically necessary.
Providers need to have a(n) ________________signed by the patient prior to services if they
believe that Medicare will not cover the services. - correct answer-ABN form
Response Feedback:
An ABN must always be signed prior to the services being done
