CPCO Exam Questions and Verified Answers
(2023/ 2024 Latest Update!!)
1. Services furnished in teaching settings are paid under the Medicare Physician Fee
Schedule (MPFS) if the services are:
✓ Answer: Personally furnished by a physician who is not a resident.
2. Which of the following settings is the incident-to rule not applicable?
✓ Answer: Hospital
3. Assignment is a written agreement between beneficiaries, their physicians or other
suppliers, and Medicare. The beneficiary agrees to let the physician or other suppliers
request direct payment from Medicare for covered Part B services, equipment, and
supplies by assigning the claim to the physician or supplier. As a result of a physician
accepting assignment, he/she must follow certain requirements. Which of the statements
does not accurately reflect the requirements of physicians accepting assignment?
✓ Answer: Physicians or suppliers who have chosen to accept assignment
may as a result collect from the enrollee or anyone else any amount
which, when added to the benefit, may exceed the Medicare allowed
amount.
4. According the Social Security Act, Sec. 1877. [42 U.S.C. 1395], prohibitions on certain
referral arrangements include those that involve financial arrangements between entities
and physician practices. In the law, rental of office space is considered not to be a
compensation arrangement under certain conditions and as such are considered
exceptions as long as which of the following exists?
✓ Answer: A. The lease would be commercially reasonable even if no
referrals were made between the parties
✓ B. The lease provides for a term of rental or lease for at least 1 year
, ✓ C. The space rented or leased does not exceed that which is reasonable
and necessary for the legitimate business purposes of the lease or rental
and is used exclusively by the lessee when being used by the lessee
✓ D. The rental charges over the term of the lease are set in advance, are
consistent with fair market value, and are not determined in a manner
that takes into account the volume or value of any referrals or other
business generated between the parties
5. According to the Federal Register, the OIG has listed a number of potential risk areas for
physician practices. These risk areas include: (a) coding and billing, (b) reasonable and
necessary services, and (c) documentation. Which of the following would be considered a
risk area or areas for a physician practice?
✓ Answer: Dr. Y bills Medicare using a covered office visit code when the
actual service was a non-covered annual physical. This could be
considered improper coding or billing and therefore is considered a risk
area.
6. There can be a variety of risks associated with joint ventures between hospitals and
physicians. What law(s) could be violated for improper joint ventures?
✓ Answer: False Claims Act, Stark Laws, Anti-kickback Statute
7. Dr. Appleton is an orthopedic surgeon in a large orthopedic practice. Due to the success
of their clinic, the practice is opening a new orthopedic hospital that will be owned by all
of the physicians in the group. In addition to Stark Law issues, what other compliance
concern may be present?
✓ Answer: Dr. Appleton's ownership in the orthopedic hospital represents
a conflict of interest because his decisions on the care needed by his
patients may be biased by his potential financial gain for referring
patients to the facility.
(2023/ 2024 Latest Update!!)
1. Services furnished in teaching settings are paid under the Medicare Physician Fee
Schedule (MPFS) if the services are:
✓ Answer: Personally furnished by a physician who is not a resident.
2. Which of the following settings is the incident-to rule not applicable?
✓ Answer: Hospital
3. Assignment is a written agreement between beneficiaries, their physicians or other
suppliers, and Medicare. The beneficiary agrees to let the physician or other suppliers
request direct payment from Medicare for covered Part B services, equipment, and
supplies by assigning the claim to the physician or supplier. As a result of a physician
accepting assignment, he/she must follow certain requirements. Which of the statements
does not accurately reflect the requirements of physicians accepting assignment?
✓ Answer: Physicians or suppliers who have chosen to accept assignment
may as a result collect from the enrollee or anyone else any amount
which, when added to the benefit, may exceed the Medicare allowed
amount.
4. According the Social Security Act, Sec. 1877. [42 U.S.C. 1395], prohibitions on certain
referral arrangements include those that involve financial arrangements between entities
and physician practices. In the law, rental of office space is considered not to be a
compensation arrangement under certain conditions and as such are considered
exceptions as long as which of the following exists?
✓ Answer: A. The lease would be commercially reasonable even if no
referrals were made between the parties
✓ B. The lease provides for a term of rental or lease for at least 1 year
, ✓ C. The space rented or leased does not exceed that which is reasonable
and necessary for the legitimate business purposes of the lease or rental
and is used exclusively by the lessee when being used by the lessee
✓ D. The rental charges over the term of the lease are set in advance, are
consistent with fair market value, and are not determined in a manner
that takes into account the volume or value of any referrals or other
business generated between the parties
5. According to the Federal Register, the OIG has listed a number of potential risk areas for
physician practices. These risk areas include: (a) coding and billing, (b) reasonable and
necessary services, and (c) documentation. Which of the following would be considered a
risk area or areas for a physician practice?
✓ Answer: Dr. Y bills Medicare using a covered office visit code when the
actual service was a non-covered annual physical. This could be
considered improper coding or billing and therefore is considered a risk
area.
6. There can be a variety of risks associated with joint ventures between hospitals and
physicians. What law(s) could be violated for improper joint ventures?
✓ Answer: False Claims Act, Stark Laws, Anti-kickback Statute
7. Dr. Appleton is an orthopedic surgeon in a large orthopedic practice. Due to the success
of their clinic, the practice is opening a new orthopedic hospital that will be owned by all
of the physicians in the group. In addition to Stark Law issues, what other compliance
concern may be present?
✓ Answer: Dr. Appleton's ownership in the orthopedic hospital represents
a conflict of interest because his decisions on the care needed by his
patients may be biased by his potential financial gain for referring
patients to the facility.
