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CPCO CERTIFICATION EXAM 70+ QUESTIONS AND ANSWERS .
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CPCO CERTIFICATION EXAM70+ QUESTIONS AND ANSWERS
2023 2024
1. Under the Health Insurance Portability and Accountability Act of 1996
(HIPAA), Public Law 104-191, what is the name of the national program
designed to coordinate Federal, State and local law enforcement activities
with respect to health care fraud and abuse?
A. Health Care Fraud Prevention and Enforcement Action Team (HEAT)
B. Health Care Recovery and Affordable Care Act (HCRAC)
C. Health Care Fraud and Abuse Control Program (HCFAC)
D. Health Care Civil Penalties Law: C. Health Care Fraud and Abuse Control
Program (HCFAC)
2. According to the Federal Sentencing Guidelines, "To have an effective
compliance and ethics program..., an organization shall exercise due
diligence to prevent and detect criminal conduct." The FSGs also state
organizations shall:
A. Promote an organizational culture that encourages ethical conduct and a
commitment to compliance with the law.
B. Implement mandatory compliance programs.
C. Perform annual audits to detect criminal conduct.
D. Immediately report evidence of misconduct to the authorities.: A. Promote
an organizational culture that encourages ethical conduct and a commitment to
compliance with the law.
3. If a physician practice uses another entity's standards of conduct, the
practice must:
A. Implement the standards of conduct as received because they have already
been approved.
,B. Tailor those materials to the physician practice where they will be applied.
C. Only select those standards that represent high risk issues for the practice.
D. None of the above. Physician practices must create their own standards of
conduct. It would be a compliance violation to copy another entity's
standards of conduct.: B. Tailor those materials to the physician practice where
they will be applied.
4. As the compliance contact for your physician practice, you are charged
with developing the policies and procedures related to coding and billing.
When developing these policies and procedures, which of the following
statements should be included?
A. If a new physician joins the practice and the new physician's NPI has
not been received, services performed should be reported using the practice
medical director's NPI.
B. For any services billed, documentation must be present in the patient's
medical record to support the services.
C. To avoid compliance risk, coding for E/M services should be based solely
on medical record documentation, even if it appears the level of service is
not warranted.
D. For denied services, billing staff should notify the physician to change the
reported diagnosis to allow for resubmission and payment of the claim.: B.
For any services billed, documentation must be present in the patient's medical
record to support the services.
5. City Orthopedics, a large physician group practice employs several
physician assistants and nurse practitioners. There have been several
questions by the physicians on how incident to services should be billed. The
compliance officer has called the Medicare Administrative Contractor for the
practice and was given some information on how incident to services should
be billed. Because the practice will be relying on the information received
from the Medicare Administrative Contractor, what steps should the
compliance officer take at the conclusion of the call according to the OIG
Compliance Guidance for Individual and Small Group Physician Practices?
A. Call someone else at the Medicare Administrative Contractor to confirm the
information received.
B. Send a letter to CMS to confirm the information provided by the Medicare
Administrative Contractor is correct.
C. Both A and B
, D. Document the conversation and retain th: D. Document the conversation and
retain the records.
6. Developing effective compliance policies and procedures is an important
part of any compliance program. To help your practice mitigate compliance
risk, policies and procedures should:
A. Only be one page long to promote understanding by all staff.
B. Be sure any timeframes or requirements listed can be accomplished given
the practice's resources.
C. Be written by consultants because they are more familiar with the variety
of healthcare regulations that apply to the practice.
D. Both B and C: B. Be sure any timeframes or requirements listed can be
accomplished given the practice's resources.
7. Select the best phrase from the list below to complete the following policy
statement: Centennial Medical Associates is committed to following Federal,
State, and Local laws, rules, guidelines, and regulations. To promote this
effort, Centennial Medical Associates will perform claims audits at least on an
annual basis to ____________________.
A. Maximize reimbursement for the services performed.
B. Optimize reimbursement for the services performed.
C. Verify accuracy of coding and reimbursement for the services performed.
D. Ensure all services are submitted for reimbursement.: C. Verify accuracy of
coding and reimbursement for the services performed.
8. You have just been identified as the compliance officer at your practice.
The OIG Compliance Guidance for Individual and Small Group Physician
Practices suggests six specific duties that may be assigned to you. What is
one of those duties?
A. Reviewing reports to see that new employees and vendors have been
checked against the OIG's list of excluded individuals and entities.
B. Making sure no one changes the compliance program so you are able to
show how the program was implemented.
C. Reviewing all claims being submitted to be sure they do not violate fraud
and abuse laws.
D. Submitting annual reports to the Office of Inspector General on all com-
pliance activities undertaken during the year.: A. Reviewing reports to see that
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