CPCO EXAM
Question 1
Under Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996
(HIPAA), 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? - correct
answer-Health Care Fraud and Abuse Control Program (HCFAC)
Question 2
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: - correct answer-Promote an
organizational culture that encourages ethical conduct and a commitment to compliance with
the law.
Question 3
If a physician practice uses another entity's standards of conduct, the practice must: - correct
answer-Tailor those materials to the physician practice where they will be applied.
Question 4
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? - correct answer-For any
services billed, documentation must be present in the patient's medical record to support the
services.
Question 5
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 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? - correct answer-Document the conversation and retain the
records.
Question 6
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: - correct answer-Be sure any time frames or requirements listed can be
accomplished given the practice's resources.
Question 7
Select the best phrase from the list below to complete the following policy statement:
Centennial Medical Associates is committed to following Federal, State, and Local laws,
, rules, guidelines, and regulations. To promote this effort, Centennial Medical Associates will
perform claims audits at least on an annual basis to ____________________. - correct
answer-Verify accuracy of coding and reimbursement for the services performed.
Question 8
You have just been identified as the compliance officer at your practice. The OIG
Compliance Guidance for Individual and Small Group Physician Practices suggests six
specific duties that may be assigned to you. What is one of those duties? - correct
answer-Reviewing reports to see that new employees and vendors have been checked
against the OIG's list of excluded individuals and entities.
Question 9
For larger physician practices, how frequently does the OIG recommend reporting
compliance activities to the Board of Directors and CEO? - correct answer-Regularly
Question 10
When conducting compliance training within a physician practice, what is one of the goals
that the practice should strive for in this compliance training? - correct answer-All employees
will receive training on how to perform their jobs in compliance with the standards of the
practice and any applicable regulations.
Question 11
What is the goal of ongoing auditing and monitoring in a physician's practice? - correct
answer-Ongoing auditing and monitoring will evaluate whether the physician practice's
standards and procedures are current and accurate and whether the compliance program is
working.
Question 12
A compliance program's plan for communication should include a provision for
non-retaliation for reporting fraudulent conduct. Which method below helps ensure that an
employee would be free from retribution? - correct answer-Well-publicized disciplinary
actions for retaliation
Question 13
What does the HHS OIG suggest as possible warning signs that non-compliance may exist?
- correct answer-Significant change in the number or type of claim rejections.
Question 14
Having the ability to respond to issues enables a practice to develop effective action plans to
correct problems and prevent future problems from occurring. What is one step that can be
taken to establish compliance effectiveness for the response/prevention element? - correct
answer-Create a response team, consisting of representatives from compliance, audit, and
any other relevant functional department.
Question 15
A physician office laboratory is authorized to perform urinalysis testing, including the
microscopic analysis under their PPMP certification. It has been the physician's experience
that many of his patients that have urinalysis testing done also require the microscopic
Question 1
Under Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996
(HIPAA), 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? - correct
answer-Health Care Fraud and Abuse Control Program (HCFAC)
Question 2
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: - correct answer-Promote an
organizational culture that encourages ethical conduct and a commitment to compliance with
the law.
Question 3
If a physician practice uses another entity's standards of conduct, the practice must: - correct
answer-Tailor those materials to the physician practice where they will be applied.
Question 4
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? - correct answer-For any
services billed, documentation must be present in the patient's medical record to support the
services.
Question 5
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 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? - correct answer-Document the conversation and retain the
records.
Question 6
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: - correct answer-Be sure any time frames or requirements listed can be
accomplished given the practice's resources.
Question 7
Select the best phrase from the list below to complete the following policy statement:
Centennial Medical Associates is committed to following Federal, State, and Local laws,
, rules, guidelines, and regulations. To promote this effort, Centennial Medical Associates will
perform claims audits at least on an annual basis to ____________________. - correct
answer-Verify accuracy of coding and reimbursement for the services performed.
Question 8
You have just been identified as the compliance officer at your practice. The OIG
Compliance Guidance for Individual and Small Group Physician Practices suggests six
specific duties that may be assigned to you. What is one of those duties? - correct
answer-Reviewing reports to see that new employees and vendors have been checked
against the OIG's list of excluded individuals and entities.
Question 9
For larger physician practices, how frequently does the OIG recommend reporting
compliance activities to the Board of Directors and CEO? - correct answer-Regularly
Question 10
When conducting compliance training within a physician practice, what is one of the goals
that the practice should strive for in this compliance training? - correct answer-All employees
will receive training on how to perform their jobs in compliance with the standards of the
practice and any applicable regulations.
Question 11
What is the goal of ongoing auditing and monitoring in a physician's practice? - correct
answer-Ongoing auditing and monitoring will evaluate whether the physician practice's
standards and procedures are current and accurate and whether the compliance program is
working.
Question 12
A compliance program's plan for communication should include a provision for
non-retaliation for reporting fraudulent conduct. Which method below helps ensure that an
employee would be free from retribution? - correct answer-Well-publicized disciplinary
actions for retaliation
Question 13
What does the HHS OIG suggest as possible warning signs that non-compliance may exist?
- correct answer-Significant change in the number or type of claim rejections.
Question 14
Having the ability to respond to issues enables a practice to develop effective action plans to
correct problems and prevent future problems from occurring. What is one step that can be
taken to establish compliance effectiveness for the response/prevention element? - correct
answer-Create a response team, consisting of representatives from compliance, audit, and
any other relevant functional department.
Question 15
A physician office laboratory is authorized to perform urinalysis testing, including the
microscopic analysis under their PPMP certification. It has been the physician's experience
that many of his patients that have urinalysis testing done also require the microscopic
