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CPCO CERTIFICATION EXAM LATEST
EXAM 2024 | ALL QUESTIONS AND
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What does the HHS OIG suggest as possible warning signs that non- compliance may exist? A. Significant change in the number or type of claim rejections. B. Getting carrier newsletters pertaining to the types of service that your practice bills. C. Consistent use of certain codes. D. Receipt of carrier requests for documentation. ------CORRECT ANSWER---------------A. Significant change in the number or type of claim rejections. Having the ability to respond to issues enables a practice to develop effective action plans to correct problems and prevent future problems from occurring. What is one step that can be taken to establish compliance effectiveness for responding to and/or preventing compliance issues? A. Create a response team, consisting of representatives from the compliance and audit department. B. Create a response team, consisting of representatives from compliance, audit, and any other relevant functional department. C. Create an investigation team, consisting of representatives from compliance, audit, and any other relevant functional department. D. Create a prevention team, consisting of representatives from compliance, audit, and any other relevant functional department. ------ CORRECT ANSWER---------------B. Create a response team, consisting of representatives from compliance, audit, and any other relevant functional department.
A physician office laboratory is authorized to perform urinalysis testing, including the microscopic analysis under their Provider-Performed Microscopy Procedures (PPMP) certification. It has been the physician's experience that many of his patients that have urinalysis testing done also requires the microscopic exam. Because of this and to be able to provide better treatment, he has established an office policy that for all urinalysis testing performed in his office, the lab should also perform the microscopic test. Is this a compliance risk? A. Yes. Performing the microscopic test on all patients when the results of the urinalysis are negative could be considered medically unnecessary. B. Yes. The physician must always order the code for the urinalysis test with the microscopic exam to avoid unbundling. C. No. Because the physician is providing quality patient care, there is no compliance risk. D. No. The physici ------CORRECT ANSWER---------------A. Yes. Performing the microscopic test on all patients when the results of the urinalysis are negative could be considered medically unnecessary. Billing companies should have written policies and procedures that reflect and reinforce Federal and State statutes. These policies must create a mechanism for the billing or reimbursement staff to communicate effectively and accurately with the health care provider. Which of the following policies and procedures should a billing office have in place to meet these needs? A. Conclude that claims may be submitted when note has been started but not yet finalized by the physician as long as a signed affidavit is in place in the office granting the staff power to provide coding based on preliminary reports. B. Provide incentives to billing and coding staff in the form of compensation for productivity to ensure full revenue recovery of all claims in a timely fashion. C. Establish and maintain a process for pre- and post-submission review of claims to ensure claims submitted for reimbursement accurately represent
requirement identified in federal or state law, or internal policies and procedures. A patient being seen by a physician has unpaid medical bills in excess of $5,000 after insurance payments. The patient has now lost his job and has limited financial resources. The office manager has reviewed the patient's financial situation to assess the patient's ability to pay and has agreed to reduce the fees owed to $2,500. Would this act violate the OIG gift allowance for beneficiaries? A. Yes, the OIG gift allowance must be followed, even if a patient is unable to pay. B. Yes, by discounting the price to the patient, the practice must now increase fees to other payers, including Medicare, to make up the difference which is not allowed. C. No, this would be an exception to the OIG gift allowance because it is based on the patient's ability to pay. D. No, as long as the practice spreads out the fee reduction over more than one year. ------CORRECT ANSWER---------------C. No, this would be an exception to the OIG gift allowance because it is based on the patient's ability to pay. Services furnished in teaching settings are paid under the Medicare Physician Fee Schedule (MPFS) if the services are: A. Documented and co-signed by the teaching physician identifying that he/she agrees with the residents note as long as he/she personally reviewed the record and agreed with the resident. B. Furnished by a medical student when a teaching physician is providing direct supervision during the critical or key portions of the service. C. Furnished by a medical student under a primary care exception within an approved Graduate Medical Education (GME) Program as long as the teaching physician is providing direct supervision during the critical or key portions of the service.
D. Personally furnished by a physician who is not a resident. ------ CORRECT ANSWER---------------D. Personally furnished by a physician who is not a resident. 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 ------CORRECT ANSWER--------------- A. Hospital 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 am ------CORRECT 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. 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
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 ------CORRECT ANSWER---------------D. All of the above 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 orthopedi ------CORRECT ANSWER---------------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. Physician Quack just completed a 15-minute psychiatric evaluation of his patient. He intentionally completes his superbill for a 30- 45 - minute session. Dr. Quack may be liable for: A. Abuse B. Neglect C. Fraud D. None of the above ------CORRECT ANSWER---------------C. Fraud
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 ------CORRECT ANSWER---------------C. Health Care Fraud and Abuse Control Program (HCFAC) 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. ------ CORRECT ANSWER---------------A. Promote an organizational culture that encourages ethical conduct and a commitment to compliance with the law. 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.
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 ------CORRECT ANSWER------ ---------D. Document the conversation and retain the records. 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 ------CORRECT ANSWER---------------B. Be sure any timeframes or requirements listed can be accomplished given the practice's resources. 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. ------CORRECT ANSWER---------------C. Verify accuracy of coding and reimbursement for the services performed.
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 compliance activities undertaken during the year. ------CORRECT ANSWER---------------A. Reviewing reports to see that new employees and vendors have been checked against the OIG's list of excluded individuals and entities. For larger physician practices, how frequently does the OIG recommend reporting compliance activities to the Board of Directors and CEO? A. Monthly B. Quarterly C. Annually D. Regularly ------CORRECT ANSWER---------------D. Regularly When conducting compliance training within a physician practice, what is one of the goals that the practice should strive for in this training? A. Only new employees will receive training on how to perform their jobs in compliance with the standards of the practice and any applicable regulations. B. Managers of employees will receive training on how to perform their jobs in compliance with the standards of the practice and any applicable regulations.
The civil False Claims Act provides the Court with the authority to assess: A. One "times the amount of the damages which the Government sustains..." B. Up to two "times the amount of the damages which the Government sustains..." C. Up to three "times the amount of the damages which the Government sustains..." D. Up to four "times the amount of the damages which the Government sustains..." ------CORRECT ANSWER---------------C. Up to three "times the amount of the damages which the Government sustains..." The Federal Anti-Kickback Statute places certain constraints on business arrangements related directly or indirectly to items or services reimbursed by any Federal health care program, including, but not limited to, Medicare and Medicaid. According to the OIG, which of the following would likely be an acceptable practice? A. A physician practice should participate in all aspects of a hospital's compliance program to be sure the anti-kickback statute is not violated. B. The hospital should oversee the physician practice's compliance program at no cost for the physicians in exchange for timely and accurate completion of inpatient records. C. The physician practice should limit participation in a hospital's compliance program to training and education or policies and procedures only. D. A hospital performs an annual claim audit for its affiliated physician practices. There is no charge for the audit as the hospital inc ------ CORRECT ANSWER---------------C. The physician practice should limit participation in a hospital's compliance program to training and education or policies and procedures only. Although liability under the anti-kickback statute ultimately turns on a party's intent, it is possible to identify arrangements or practices that may present a significant potential for abuse. Which of the following questions
would be helpful to determine whether a proposed action could violate the anti-kickback statute? A. Does the arrangement or practice have a potential to improve clinical decision-making? B. Does the arrangement or practice have a potential to decrease costs to Federal health care programs, beneficiaries, or enrollees? C. Does the arrangement or practice have a potential to decrease the risk of overutilization or inappropriate utilization? D. Does the arrangement or practice raise patient safety or quality of care concerns? ------CORRECT ANSWER---------------C. Does the arrangement or practice have a potential to decrease the risk of overutilization or inappropriate utilization? Section 101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) - Pub. L. 108-173, December 8, 2003 - authorized an exception to the physician self-referral prohibition for certain arrangements in which the physician can receive necessary non-monetary remuneration. What is this exception related to? A. Outpatient services B. E-Prescribing C. Physician investments in specialty hospitals D. None of the above; there are no exceptions in the Stark law. ------ CORRECT ANSWER---------------B. E-Prescribing Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), is also known as the physician self-referral law and commonly referred to as the "Stark Law". The Stark Law applies to which of the following individuals or entities? A. Patients and their families B. Physicians and hospitals C. Federal health care programs like Medicare D. Both B and C ------CORRECT ANSWER---------------D. Both B and C
The HIPAA security rules require covered entities to put safeguards in place to protect personal health information. A medical facility hired a Security Officer who had done a risk analysis to identity potential security risks of the computer system. He has implemented policies and procedures on computer access and password management. What type of safeguard does this action describe? A. Technical safeguards B. Lifesaving safeguards C. Physical safeguards D. Administrative safeguards ------CORRECT ANSWER---------------D. Administrative safeguards A safeguard the security officer puts in place is that all employees were given name tags to wear while on duty. Policies were put in place to restrict access to employee areas. Policies were also written to establish the proper use of computer workstations for business and antivirus software was added. What type of safeguard does this action describe? A. Technical safeguards B. Lifesaving safeguards C. Physical safeguards D. Administrative safeguards ------CORRECT ANSWER---------------A. Technical safeguards When is a covered entity required to provide the patient with a copy of the notice of privacy practices? A. They are only required to post it in their office and do not have to give the patient a copy. B. Any time the patient comes to the office and the staff remembers to give them one. C. At the first services encounter by personal delivery and obtain a written acknowledgement.
D. They are only required to post the notice of privacy practices on their website. ------CORRECT ANSWER---------------C. At the first services encounter by personal delivery and obtain a written acknowledgement. Which of the following areas would not be covered under EMTALA? A. A physical therapy department of the hospital located in a new office complex located two miles from the hospital. B. A provider-based department that is licensed as an emergency department. C. A hospital owned/operated physician practice that provides advertised emergency care in an urgent care clinic located 10 miles from the hospital. D. The hospital parking lot. ------CORRECT ANSWER---------------A. A physical therapy department of the hospital located in a new office complex located two miles from the hospital. Dr. Amber is the emergency department physician at Orangevale Hospital. A patient arrives complaining of chest pains, dizziness, and shortness of breath for the past three hours. What is the first thing Dr. Amber must do to comply with EMTALA? A. Make sure the patient has been properly registered with the hospital so they can begin pre-authorizing services. B. Provide a medical screening examination to determine if the patient has a medical emergency. C. Provide a medical screening examination to determine where the patient should be transferred. D. Immediately transfer the patient to Heart Hospital because they have a much better cardiac care program. ------CORRECT ANSWER---------------B. Provide a medical screening examination to determine if the patient has a medical emergency. What is the most common type of laboratory?
Any health care fraud scheme that disseminate any article or document through a "common mail carrier" may be the basis for a charge of: A. Mail Fraud B. Wire Fraud C. Mail Fraud and Wire Fraud D. False Claims ------CORRECT ANSWER---------------A. Mail Fraud When agreeing to a global civil fraud settlement, what is the most popular reason why a provider agrees to enter into a Corporate Integrity Agreement? A. To avoid exclusion from participation in Federal health care programs B. To obtain a Civil Monetary Penalty reduction C. To obtain a fine reduction D. To avoid incarceration ------CORRECT ANSWER---------------A. To avoid exclusion from participation in Federal health care programs A new orthopedic physician is being hired in a group practice. The group has been searching for quite a while and finally found the perfect candidate. As part of the practice's hiring process, employees must be checked against the OIG and GSA lists for excluded parties. Does this practice also apply to physicians? A. No, this requirement only applies to non-medical employees of the practice. B. No, this requirement only applies to non-medical employees of the practice and vendors. C. Yes, this requirement only applies to physicians. D. Yes, this requirement applies to physicians and employees of the practice. ------CORRECT ANSWER---------------D. Yes, this requirement applies to physicians and employees of the practice.
A physician practice hired a consultant to perform external audit services for their practice. After the consultant began working, the OIG and GSA lists were checked and it was found the consultant was excluded from participation. What steps should the practice take? A. Nothing. Because the consultant is not ordering, referring, or performing medical services, there is no problem. B. Report the consultant to the OIG for violating her exclusion status. C. Immediately ask the consultant to stop work. D. Contact legal counsel. E. Both C and D ------CORRECT ANSWER---------------E. Both C and D Which entity provides benefit integrity investigations based on billing abnormalities identified by data analysis or allegations of fraud and abuse, as well as conducts reviews that will allow them to compare billing of Medicare claims to Medicaid claims known as the "Medi-Medi" program that helps to identify fraudulent activity between the two programs? A. Medi-Medi Audit Contractors (MACs) B. Recovery Audit Contractors (RACs) C. Medicaid Integrity Contractors (MICs) D. Zone Program Integrity Contractors (ZPICs) ------CORRECT ANSWER-- -------------D. Zone Program Integrity Contractors (ZPICs) Federal and state investigators are in the process of identifying and copying documents that are identified in the Government's search warrant. Which of the following statements are true regarding document protection? A. Employees should not destroy, change or alter any documents, including paper, tape and electronic records because such actions can lead to criminal liability. B. Documents should not be moved but it is ok to amend records in an attempt to correct the information in them. C. Let the investigator know that some documents will be destroyed because the office policy on routine record destruction cannot be suspended.
