CPCO Chapter Review 2 OIG Compliance Program Guidance
for Individual and Small Physician Practices Exam (Latest
) Tested Questions with Revised Answers, (A+
Guarantee)
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? - CORRECT ANSWERS compliance
officer
Response Feedback:
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.
The OIG has described seven basic components of an effective compliance program for a small physician
practice that are based from the _______________? - CORRECT ANSWERS Federal Sentencing
Guidelines
Response Feedback:
All Compliance Programs should be built upon the foundation of the seven basic components as listed in
the Federal Sentencing Guidelines, but the size and nature of the organization will determine what and
how each issue is to be addressed.
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? - CORRECT
ANSWERS Monitoring
Response Feedback:
Audits are performed based on specific guidelines or concerns. Monitoring is ongoing spot checks to
identify any potential risk areas.
, 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? - CORRECT ANSWERS Areas of risk need to be assessed
Response Feedback:
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)
When the term "Open Door Policy" is used in reference to effective communication, what is this
referring to? - CORRECT ANSWERS The Compliance Officer is accessible to all employees via
many methods of communication
Response Feedback:
The OIG recommends an "open door" policy between the physicians and compliance personnel and
practice employees. This policy can be implemented with less formal communication techniques, such
as conspicuous notices posted in common areas and/or the development of compliance bulletin board,
etc. Many various options are available when using an "open door" policy.
How often should the Tim, Compliance Officer for XYZ Community Hospital, update the compliance
program and plan? - CORRECT ANSWERS As laws and regulations change; and at least annually
Response Feedback:
The Compliance Officer is also responsible for periodic review and updating the Compliance Program. As
needs of the organization change, and as laws and regulations change, the Compliance Program must
adapt
for Individual and Small Physician Practices Exam (Latest
) Tested Questions with Revised Answers, (A+
Guarantee)
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? - CORRECT ANSWERS compliance
officer
Response Feedback:
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.
The OIG has described seven basic components of an effective compliance program for a small physician
practice that are based from the _______________? - CORRECT ANSWERS Federal Sentencing
Guidelines
Response Feedback:
All Compliance Programs should be built upon the foundation of the seven basic components as listed in
the Federal Sentencing Guidelines, but the size and nature of the organization will determine what and
how each issue is to be addressed.
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? - CORRECT
ANSWERS Monitoring
Response Feedback:
Audits are performed based on specific guidelines or concerns. Monitoring is ongoing spot checks to
identify any potential risk areas.
, 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? - CORRECT ANSWERS Areas of risk need to be assessed
Response Feedback:
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)
When the term "Open Door Policy" is used in reference to effective communication, what is this
referring to? - CORRECT ANSWERS The Compliance Officer is accessible to all employees via
many methods of communication
Response Feedback:
The OIG recommends an "open door" policy between the physicians and compliance personnel and
practice employees. This policy can be implemented with less formal communication techniques, such
as conspicuous notices posted in common areas and/or the development of compliance bulletin board,
etc. Many various options are available when using an "open door" policy.
How often should the Tim, Compliance Officer for XYZ Community Hospital, update the compliance
program and plan? - CORRECT ANSWERS As laws and regulations change; and at least annually
Response Feedback:
The Compliance Officer is also responsible for periodic review and updating the Compliance Program. As
needs of the organization change, and as laws and regulations change, the Compliance Program must
adapt
