CPCO Certification Exam| Questions and
Verified Answers| 2023/ 2024 Latest
Update!!!
QUESTION
Which of the following settings is the incident-to rule not applicable?
A. Hospital
B. Solo-Physician office
C. Group Practice
D. Multi-Disciplinary Group Practice
Answer:
A. Hospital
QUESTION
An 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?
A. The physician/supplier who accepts assignment on a claim-by-claim basis or who is a
participating physician/supplier is precluded from charging the enrollee more than the deductible
and coinsurance based upon the approved payment amount determination.
B. Physicians or suppliers who agree to accept assignment from Medicare cannot attempt to
collect more than the appropriate Medicare deductible and coinsurance amounts from the
beneficiary, his/her other insurance, or anyone else.
C. 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.
D
Answer:
,C. 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.
QUESTION
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?
A. The lease would be commercially reasonable even if no referrals were made between the
parties and has a term or rental or lease for at least one 1 year.
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
E. All of the above
Answer:
E. All of the above
QUESTION
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 scenarios would be considered a risk
area or areas for a physician practice?
A. 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.
B. Dr. X bills Medicare using a CPT surgical code including dressings and instruments for a
minor procedure in which dressings and instruments are included in a single fee. This could be
considered improper coding or billing and therefore is considered a risk area.
C. Dr. Z bills Medicare for a preventive medicine service 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.
, D. Dr. T bills Medicare with a modifier, as defined by the CPT manual, to indicate that a service
or procedure which has been performed has been altered. This could be considered improper c
Answer:
A. 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.
QUESTION
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?
A. False Claims Act
B. Stark Laws
C. Anti-kickback Statute
D. All of the above
Answer:
D. All of the above
QUESTION
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?
A. Dr. Appleton's referral of patients to the orthopedic hospital will violate the False Claims Act
and subject him to the associated penalties and fines.
B. Dr. Appleton and his colleagues will be paid a set amount of the profits, regardless of the
value or volume of referrals.
C. 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.
D. There is no compliance concern. By opening a new orthopedic hospital, the practice is helping
to assure needed orthopedic care to the community.
Verified Answers| 2023/ 2024 Latest
Update!!!
QUESTION
Which of the following settings is the incident-to rule not applicable?
A. Hospital
B. Solo-Physician office
C. Group Practice
D. Multi-Disciplinary Group Practice
Answer:
A. Hospital
QUESTION
An 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?
A. The physician/supplier who accepts assignment on a claim-by-claim basis or who is a
participating physician/supplier is precluded from charging the enrollee more than the deductible
and coinsurance based upon the approved payment amount determination.
B. Physicians or suppliers who agree to accept assignment from Medicare cannot attempt to
collect more than the appropriate Medicare deductible and coinsurance amounts from the
beneficiary, his/her other insurance, or anyone else.
C. 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.
D
Answer:
,C. 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.
QUESTION
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?
A. The lease would be commercially reasonable even if no referrals were made between the
parties and has a term or rental or lease for at least one 1 year.
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
E. All of the above
Answer:
E. All of the above
QUESTION
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 scenarios would be considered a risk
area or areas for a physician practice?
A. 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.
B. Dr. X bills Medicare using a CPT surgical code including dressings and instruments for a
minor procedure in which dressings and instruments are included in a single fee. This could be
considered improper coding or billing and therefore is considered a risk area.
C. Dr. Z bills Medicare for a preventive medicine service 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.
, D. Dr. T bills Medicare with a modifier, as defined by the CPT manual, to indicate that a service
or procedure which has been performed has been altered. This could be considered improper c
Answer:
A. 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.
QUESTION
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?
A. False Claims Act
B. Stark Laws
C. Anti-kickback Statute
D. All of the above
Answer:
D. All of the above
QUESTION
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?
A. Dr. Appleton's referral of patients to the orthopedic hospital will violate the False Claims Act
and subject him to the associated penalties and fines.
B. Dr. Appleton and his colleagues will be paid a set amount of the profits, regardless of the
value or volume of referrals.
C. 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.
D. There is no compliance concern. By opening a new orthopedic hospital, the practice is helping
to assure needed orthopedic care to the community.
