CPCO prep
Does Medicare pay for all tests ordered by Providers? - correct answer-No, they need to
determine if it's covered and medically necessary.
For larger physician practices, how often does the OIG suggest reporting compliance
activities to the board of directors? - correct answer-Regularly
According to the OIG, medically unnecessary services can be billed to Medicare for what
purpose? - correct 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? - correct
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? - correct
answer-1992
Which department of the OIG is responsible for providing mission and administrative support
to the OIG? - correct 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? - correct 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? - correct answer-Have a robust and effective compliance
program
A majority of the OIG's resources goes to oversight of which programs? - correct
answer-Medicare and Medicaid
What year was the Patient Protection and Affordable Care Act (PPACA) enacted? - correct
answer-2010
What does the acronym LEP stand for? - correct answer-Limited English Proficiency
Everyone should be educated in their role in adhering to the Compliance Program including
their duty to report_______________. - correct answer-Suspected misconduct
Employees have ____________to report erroneous conduct, without repercussion, so that it
may be corrected immediately. - correct 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? - correct 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. -
correct 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________? -
correct 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 ___________. - correct 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 _________. - correct answer-Empowered.
The mission statement of the healthcare organization and a statement of why they are in
business are also know as ___________? - correct answer-The code of conduct.
The compliance officer will report directly to - correct answer-The managing physicians and
board
How many components are required by the OIG to have an effective Compliance Program? -
correct answer-7
What will show a third party's good faith toward remediation? - correct answer-Compliance
Program
What is the Federal agency that provides compliance program guidance to providers and
covered entities? - correct 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 - correct 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? -
correct 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 ____________ -
correct 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 ___________. - correct
answer-Compliance Coordinator.
,What can result in imprisonment and penalties for providers and covered entities? - correct
answer-Medical fraud
What two laws relate primarily to the relationships between referral sources, such as
physicians and hospitals? - correct answer-Anti-kickback and Stark Laws.
If physician recruitment arrangements are not properly structured, it can result in
________________ - correct answer-EMTALA violations
Penalties under the FCA include how much - correct 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? - correct answer-Suspend the employee, request documentation,
and investigate the matter.
Some joint ventures may violate the Medicare and Medicaid ______________. - correct
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. - correct 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? -
correct answer-Stark
Which law increases the severity of penalties for violations involving organized crime? -
correct 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? - correct answer-Stark
Which of these responsibilities is not one of a compliance officer? - correct answer-Create all
policies and procedures
What are key responsibilities of a compliance officer? - correct 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? - correct answer-2009
What policy is important in dealing with employee concerns? - correct
answer-Non-Retaliation policy
When can a covered entity disclose PHI without a patient's consent? - correct answer-When
providing in cases of suspected abuse.
What covered entity as the most HIPAA breaches? - correct answer-Business Associates
How soon are practices or medical organizations required to process record requests? -
correct answer-Within 30 days
What does HITECH stand for? - correct answer-Health Information Technology for Economic
and Clinical Health
What safeguard is defined as measures to protect electronic systems? - correct
answer-Physical safeguards
What does the term "Disclosure" mean? - correct 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 - correct answer-Deny claims
If a person presents to the emergency department and collapses outside the ER doors, is
EMTLA evoked? - correct answer-Yes, the 250 yard zone applies in this case.
CLIA is funded by whom? - correct 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? -
correct answer-No, EMTALA does not include physician practices.
Requirements for transferring an unstable patient include all but ____________ - correct
answer-making sure the patient has either Medicare or Medicaid
Under EMTALA, the following requirements must be met when transferring an unstable
patient: - correct answer-Consent of receiving hospital
Patient's consent must be documented
Physician must attest the medical benefits outweigh the risk of the transfer in writing
To enroll in the CLIA program, laboratories must first register by completing an application,
pay fees, be surveyed, and if applicable become what? - correct answer-Certified
Does Medicare pay for all tests ordered by Providers? - correct answer-No, they need to
determine if it's covered and medically necessary.
For larger physician practices, how often does the OIG suggest reporting compliance
activities to the board of directors? - correct answer-Regularly
According to the OIG, medically unnecessary services can be billed to Medicare for what
purpose? - correct 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? - correct
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? - correct
answer-1992
Which department of the OIG is responsible for providing mission and administrative support
to the OIG? - correct 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? - correct 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? - correct answer-Have a robust and effective compliance
program
A majority of the OIG's resources goes to oversight of which programs? - correct
answer-Medicare and Medicaid
What year was the Patient Protection and Affordable Care Act (PPACA) enacted? - correct
answer-2010
What does the acronym LEP stand for? - correct answer-Limited English Proficiency
Everyone should be educated in their role in adhering to the Compliance Program including
their duty to report_______________. - correct answer-Suspected misconduct
Employees have ____________to report erroneous conduct, without repercussion, so that it
may be corrected immediately. - correct 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? - correct 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. -
correct 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________? -
correct 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 ___________. - correct 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 _________. - correct answer-Empowered.
The mission statement of the healthcare organization and a statement of why they are in
business are also know as ___________? - correct answer-The code of conduct.
The compliance officer will report directly to - correct answer-The managing physicians and
board
How many components are required by the OIG to have an effective Compliance Program? -
correct answer-7
What will show a third party's good faith toward remediation? - correct answer-Compliance
Program
What is the Federal agency that provides compliance program guidance to providers and
covered entities? - correct 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 - correct 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? -
correct 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 ____________ -
correct 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 ___________. - correct
answer-Compliance Coordinator.
,What can result in imprisonment and penalties for providers and covered entities? - correct
answer-Medical fraud
What two laws relate primarily to the relationships between referral sources, such as
physicians and hospitals? - correct answer-Anti-kickback and Stark Laws.
If physician recruitment arrangements are not properly structured, it can result in
________________ - correct answer-EMTALA violations
Penalties under the FCA include how much - correct 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? - correct answer-Suspend the employee, request documentation,
and investigate the matter.
Some joint ventures may violate the Medicare and Medicaid ______________. - correct
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. - correct 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? -
correct answer-Stark
Which law increases the severity of penalties for violations involving organized crime? -
correct 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? - correct answer-Stark
Which of these responsibilities is not one of a compliance officer? - correct answer-Create all
policies and procedures
What are key responsibilities of a compliance officer? - correct 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? - correct answer-2009
What policy is important in dealing with employee concerns? - correct
answer-Non-Retaliation policy
When can a covered entity disclose PHI without a patient's consent? - correct answer-When
providing in cases of suspected abuse.
What covered entity as the most HIPAA breaches? - correct answer-Business Associates
How soon are practices or medical organizations required to process record requests? -
correct answer-Within 30 days
What does HITECH stand for? - correct answer-Health Information Technology for Economic
and Clinical Health
What safeguard is defined as measures to protect electronic systems? - correct
answer-Physical safeguards
What does the term "Disclosure" mean? - correct 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 - correct answer-Deny claims
If a person presents to the emergency department and collapses outside the ER doors, is
EMTLA evoked? - correct answer-Yes, the 250 yard zone applies in this case.
CLIA is funded by whom? - correct 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? -
correct answer-No, EMTALA does not include physician practices.
Requirements for transferring an unstable patient include all but ____________ - correct
answer-making sure the patient has either Medicare or Medicaid
Under EMTALA, the following requirements must be met when transferring an unstable
patient: - correct answer-Consent of receiving hospital
Patient's consent must be documented
Physician must attest the medical benefits outweigh the risk of the transfer in writing
To enroll in the CLIA program, laboratories must first register by completing an application,
pay fees, be surveyed, and if applicable become what? - correct answer-Certified
