CPCO Exam Prep (2023/ 2024 Update)
Questions and Verified Answers
QUESTION
If a violation has occurred, Kim, Compliance Officer at ABC Provider Group, will be required to
develop and/or coordinate what type of plan?
a. correspondence
b. self-disclosure
c. refund
d. corrective action
Answer:d. corrective action
If a violation has occurred, the Compliance Officer will be required to develop and/or coordinate
a corrective action plan. This plan should include a description of the discrepancy; a description
of the specific remedy that has been instituted, including any refunds of overpayment(s) that
have been made; any disciplinary actions that have resulted from the violation; and a copy of any
reports generated to any applicable government or third party payer.
QUESTION
Which of the following designated individuals should be the best choice to review claims in a
prospective audit before they are submitted to the payer?
a. compliance officer
b. internal certified coders
c. consultant
d. billing manager
Answer:
a. compliance officer
In a prospective audit, a designated individual (such as the CO or a designee) reviews claims
before they are submitted to the payer to ensure the appropriateness of the coding and
documentation, and adherence to health plan medical payment policies.
,QUESTION
The providers at ABC Family Medicine provide the codes for their services to the billing
department. The compliance plan requires a review of the coding once a month. This is an
example of?
a. Auditing
b. Monitoring
c. Internal Review
d. A Work Plan
Answer:b. Monitoring
Audits are performed based on specific guidelines or concerns. Monitoring is ongoing spot
checks to identify any potential risk areas.
QUESTION
The Compliance Officer is also responsible for the coordinating and/or screening of employees,
agents and independent contractors. Why is this important?
a. Organizations cannot do business with individuals who are delinquent in child support
payments
b. Organizations cannot do business with individuals who have filed bankruptcy
c. Organizations cannot do business with individuals who have been excluded from participating
in federally funded healthcare plans
d. Organizations cannot do business with individuals who have open tax liens
Answer:c. Organizations cannot do business with individuals who have been excluded from
participating in federally funded healthcare plans
The Compliance Officer is also responsible for the coordinating and/or screening of employees,
agents and independent contractors. This will involve making inquiries to the Cumulative
Sanction Report and the GSA debarred contractors listing. As specified in the Code of Conduct,
no employee or agent of the organization may have a relationship if they have a criminal
conviction related to health care or have been excluded from participating in Federally funded
healthcare plans.
QUESTION
,When physicians (or their staff) make billing mistakes and errors the most important thing to do
is _________?
a. Resubmit the claim again
b. Apply a credit to the patient account
c. Send a refund
d. Document the error
Answer:c. Send a refund
When physicians (or their staff) make billing mistakes and errors—which can happen given the
number of regulations—simply refunding payments will often settle the account.
QUESTION
The OIG guidance recommends new employees should be trained in standards and
procedures_____________ as part of their orientation to the practice.
a. 3 months after hiring the employee
b. whenever convenient
c. as soon as possible
d. 30 days after hiring the employee
Answer:c. as soon as possible
The OIG guidance recommends new employees should be trained in standards and procedures as
soon as possible as part of their orientation to the practice. It is essential that all training should
be documented in the employee's human resources file.
QUESTION
The first responsibility of the Compliance Officer is the development of the Compliance
Program. What is the first step in the process that needs to be completed before the formal
Compliance Program documents are to be drafted?
a. Policies and procedures should be developed
b. Conduct a HIPAA and OSHA audit
c. Areas of risk need to be assessed
d. Training and education should be conducted
Answer:c. Areas of risk need to be assessed
, The first responsibility of the Compliance Officer is the development of the Compliance
Program. As a first step in the process, areas of risk need to be assessed within the organization
and then the formal Compliance Program documents need to be drafted. (Remember, if there is a
Compliance Committee, the Compliance Officer will be the person to make sure that these tasks
have been completed, either by the Compliance Officer himself/herself or by members of the
committee)
QUESTION
Kelly is the Compliance Officer for a teaching hospital. The hospital has providers that
specialize in Dermatology, Pediatrics, Urology, Family Medicine, Internal Medicine and
Infectious Disease. Only the Pediatricians accept Medicaid. The Family Practice groups also
employs Nurse Practitioners whereas the other specialties only have MD's or DO's. How should
Kelly address these special issues?
a. Kelly should train all the coders and billers to know the billing rules for Medicaid and Nurse
Practitioners for all the specialties.
b. Kelly should give specialized training to the coders and billers that code/bill for the
Pediatricians and Family Practice that takes into account the Medicaid insurance and Nurse
Practitioners because this is creating extra work for two out of the six specialties.
c. These are not issues at all. Compliance and training will not be affected.
Answer:b. Kelly should give specialized training to the coders and billers that code/bill for the
Pediatricians and Family Practice that takes into account the Medicaid insurance and Nurse
Practitioners because this is creating extra work for two out of the six specialties.
Specialized compliance training is sometimes required. In some large provider groups there are
often different types of specialties.
QUESTION
What should be readily accessible to all coding staff?
Billing certification
CPT™ codebook
All essential coding resources
Questions and Verified Answers
QUESTION
If a violation has occurred, Kim, Compliance Officer at ABC Provider Group, will be required to
develop and/or coordinate what type of plan?
a. correspondence
b. self-disclosure
c. refund
d. corrective action
Answer:d. corrective action
If a violation has occurred, the Compliance Officer will be required to develop and/or coordinate
a corrective action plan. This plan should include a description of the discrepancy; a description
of the specific remedy that has been instituted, including any refunds of overpayment(s) that
have been made; any disciplinary actions that have resulted from the violation; and a copy of any
reports generated to any applicable government or third party payer.
QUESTION
Which of the following designated individuals should be the best choice to review claims in a
prospective audit before they are submitted to the payer?
a. compliance officer
b. internal certified coders
c. consultant
d. billing manager
Answer:
a. compliance officer
In a prospective audit, a designated individual (such as the CO or a designee) reviews claims
before they are submitted to the payer to ensure the appropriateness of the coding and
documentation, and adherence to health plan medical payment policies.
,QUESTION
The providers at ABC Family Medicine provide the codes for their services to the billing
department. The compliance plan requires a review of the coding once a month. This is an
example of?
a. Auditing
b. Monitoring
c. Internal Review
d. A Work Plan
Answer:b. Monitoring
Audits are performed based on specific guidelines or concerns. Monitoring is ongoing spot
checks to identify any potential risk areas.
QUESTION
The Compliance Officer is also responsible for the coordinating and/or screening of employees,
agents and independent contractors. Why is this important?
a. Organizations cannot do business with individuals who are delinquent in child support
payments
b. Organizations cannot do business with individuals who have filed bankruptcy
c. Organizations cannot do business with individuals who have been excluded from participating
in federally funded healthcare plans
d. Organizations cannot do business with individuals who have open tax liens
Answer:c. Organizations cannot do business with individuals who have been excluded from
participating in federally funded healthcare plans
The Compliance Officer is also responsible for the coordinating and/or screening of employees,
agents and independent contractors. This will involve making inquiries to the Cumulative
Sanction Report and the GSA debarred contractors listing. As specified in the Code of Conduct,
no employee or agent of the organization may have a relationship if they have a criminal
conviction related to health care or have been excluded from participating in Federally funded
healthcare plans.
QUESTION
,When physicians (or their staff) make billing mistakes and errors the most important thing to do
is _________?
a. Resubmit the claim again
b. Apply a credit to the patient account
c. Send a refund
d. Document the error
Answer:c. Send a refund
When physicians (or their staff) make billing mistakes and errors—which can happen given the
number of regulations—simply refunding payments will often settle the account.
QUESTION
The OIG guidance recommends new employees should be trained in standards and
procedures_____________ as part of their orientation to the practice.
a. 3 months after hiring the employee
b. whenever convenient
c. as soon as possible
d. 30 days after hiring the employee
Answer:c. as soon as possible
The OIG guidance recommends new employees should be trained in standards and procedures as
soon as possible as part of their orientation to the practice. It is essential that all training should
be documented in the employee's human resources file.
QUESTION
The first responsibility of the Compliance Officer is the development of the Compliance
Program. What is the first step in the process that needs to be completed before the formal
Compliance Program documents are to be drafted?
a. Policies and procedures should be developed
b. Conduct a HIPAA and OSHA audit
c. Areas of risk need to be assessed
d. Training and education should be conducted
Answer:c. Areas of risk need to be assessed
, The first responsibility of the Compliance Officer is the development of the Compliance
Program. As a first step in the process, areas of risk need to be assessed within the organization
and then the formal Compliance Program documents need to be drafted. (Remember, if there is a
Compliance Committee, the Compliance Officer will be the person to make sure that these tasks
have been completed, either by the Compliance Officer himself/herself or by members of the
committee)
QUESTION
Kelly is the Compliance Officer for a teaching hospital. The hospital has providers that
specialize in Dermatology, Pediatrics, Urology, Family Medicine, Internal Medicine and
Infectious Disease. Only the Pediatricians accept Medicaid. The Family Practice groups also
employs Nurse Practitioners whereas the other specialties only have MD's or DO's. How should
Kelly address these special issues?
a. Kelly should train all the coders and billers to know the billing rules for Medicaid and Nurse
Practitioners for all the specialties.
b. Kelly should give specialized training to the coders and billers that code/bill for the
Pediatricians and Family Practice that takes into account the Medicaid insurance and Nurse
Practitioners because this is creating extra work for two out of the six specialties.
c. These are not issues at all. Compliance and training will not be affected.
Answer:b. Kelly should give specialized training to the coders and billers that code/bill for the
Pediatricians and Family Practice that takes into account the Medicaid insurance and Nurse
Practitioners because this is creating extra work for two out of the six specialties.
Specialized compliance training is sometimes required. In some large provider groups there are
often different types of specialties.
QUESTION
What should be readily accessible to all coding staff?
Billing certification
CPT™ codebook
All essential coding resources
