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CPCO CERTIFICATION EXAM PRACTICE
EXAM 2024 | ALL QUESTIONS AND
CORRECT ANSWERS | ALREADY
GRADED A+ | LATEST RELEASE
What is the mission of the OIG? ------CORRECT ANSWER--------------- protect the integrity of Department of Health & Human Services (HHS) programs as well as the health and welfare of program beneficiaries Which OIG office conducts criminal, civil and administrative investigations of fraud and misconduct related to HHS programs, operations and beneficiaries? ------CORRECT ANSWER---------------Office of Investigations Who is responsible for enforcing the HIPAA Privacy Rule and Security Rule provisions? - -----CORRECT ANSWER---------------Office of Civil Rights (OCR) What is the OIG's Five-Principle Strategy to combat healthcare fraud, waste, and abuse? ------CORRECT ANSWER--------------- 1 - Enrollment = scrutinize individuals and entities that WANT to participate PRIOR to enrollment 2 - Payment = Establish payment methodologies that are reasonable and responsive to changes in the marketplace 3 - compliance = Assist providers and suppliers in adopting practices that promote compliance with program requirements, including quality and safety standards
4 - Oversight=Vigilantly monitor programs for evidence of fraud, waste, and abuse 5 - Response=respond swiftly to detect fraud, impose sufficient punishment and promptly remedy program vulnerabilities In February 1998, the OIG created the first compliance document. What type of provider was the first Compliance Program Guidance issued for? --- ---CORRECT ANSWER---------------Hospitals Seven elements the OIG states are necessary in an effective compliance program: ------CORRECT ANSWER--------------- 1 - Conducting internal monitoring and auditing 2 - Implementing compliance and practice standards 3 - Desiginating a compliance officer or contact 4 - Conducting appropriate training and education 5 - Responding appropriately to detected offenses and develop & implement corrective action 6 - Developing open lines of communication 7 - Enforcing disciplinary standards through well-publicized guidelines What is the target of Physician at Teaching Hospitals (PATH) audits? - ----- CORRECT ANSWER---------------documentation of physician involvement in services performed by residents and documentation for level of service provided Medicare Fraud is ___________ ------CORRECT ANSWER--------------- Knowingly submitting a false statement to obtain federal healthcare payment
According to the OIG, an effective compliance program can create what? -- ----CORRECT ANSWER---------------Financial success Customer loyalty Community support Employee satisfaction What is considered a significant element in fraud, waste and abuse? ------ CORRECT ANSWER---------------Improper payment What is considered an appropriate start to implementing an effective compliance program for compliance officers of small physician group practice with limited resources? ------CORRECT ANSWER--------------- Adopt only those components which, based on the practice's specific history with billing problems and other compliance issues are most likely to provide and identifiable benefit The OIG acknowledges that full implementation of all components of a compliance program for physician practices________- ------CORRECT ANSWER---------------may not be feasible The risk assessment is an essential component of the compliance officer's responsibilities. Once the risks have been identified and prioritized, the next step in the process is to __________. ------CORRECT ANSWER--------------
- conduct audits based on the risk assessment findings.
What is more important to have in place for enforcing and disciplining individuals who violate the practice's compliance or other practice standards? ------CORRECT ANSWER---------------Procedures For potential criminal violations, a practice should have immediate discussions with a criminal attorney who ------CORRECT ANSWER----------- ----is well versed in Healthcare Fraud and Abuse law If a compliance problem is not detected, or detected too slowly, the compliance program may require modification. What steps should the compliance officer take to determine what is necessary to prevent future violations? ------CORRECT ANSWER---------------Analyze the situation A compliance program is the _________each organization implements to achieve their stated goals. ------CORRECT ANSWER---------------Process It is important to educate employees o the methods they may utilize to directly notify and communicate issues of suspected areas of non- compliance. What is considered a best practice method of anonymous reporting? ------CORRECT ANSWER---------------Intra-office or USPS mail One of the most important elements of an effective compliance program is to have a compliance office or committee who is ------CORRECT ANSWER---------------Empowered Failure to respond quickly to suspected instances of non-compliance threatens the organization's reputation as trustworthy, law-abiding, and
If the practice uses an outsourced compliance officer, the OIG recommends________? ------CORRECT ANSWER---------------Designating a liaison from the practice to communicate with the outside compliance officer That the practice have a business service agreement with the outside compliance officer (HIPAA) What is the process that determines if the compliance program is effective? ------CORRECT ANSWER---------------Audit What is considered the most important aspect of a compliance program? --- ---CORRECT ANSWER---------------Implementation The compliance Officer is also responsible for the coordinating and/or screening of employees, agents and independent contractors. Why is this important? ------CORRECT ANSWER---------------Organizations cannot do business with individuals who have been excluded from participating in federally funded healthcare plans. The billing manager reports a significant increase of correspondence from the carriers and insurers challenging the medical necessity of claims. What is the next step the compliance officer should take regarding the reported incident? ------CORRECT ANSWER---------------Start an investigation Does Medicare pay for all tests ordered by Providers? ------CORRECT ANSWER---------------No, they need to determine if it's covered and medically necessary.
For larger physician practices, how often does the OIG suggest reporting compliance activities to the board of directors? ------CORRECT ANSWER-- -------------Regularly According to the OIG, medically unnecessary services can be billed to Medicare for what purpose? ------CORRECT ANSWER---------------To receive a denial so a claim can be submitted to a secondary payer. Which component of the OIG has a duty of operating the OIG hotline? ------ CORRECT ANSWER---------------Office of Investigations What year did the GAO identify Medicare claims to be at high risk for fraud and abuse which resulted in the OIG initiating an audit of HCFA (CMS) payment system? ------CORRECT ANSWER--------------- 1992 Which department of the OIG is responsible for providing mission and administrative support to the OIG? ------CORRECT ANSWER--------------- Office of Management and Policy Which component of the OIG has a duty of conducting audits, which results in reducing waste, abuse and mismanagement? ------CORRECT ANSWER---------------Office of Audit Services
The __________is when an organization offers another organization an incentive referrals. ------CORRECT ANSWER---------------Improper inducements. The risk assessment is an essential component of the compliance officer's responsibilities. Once risks have been identified and prioritized, the next step in the process is to________? ------CORRECT ANSWER--------------- Conduct audits based on the risk assessment findings When conducting a risk assessment, one of the most important and key sources of information that a compliance office should utilize is ___________. ------CORRECT ANSWER---------------Office of Inspector General's Annual Audit Plan One of the most important elements of an effective compliance program is to have a compliance officer or committee who is _________. ------ CORRECT ANSWER---------------Empowered. The mission statement of the healthcare organization and a statement of why they are in business are also know as ___________? ------CORRECT ANSWER---------------The code of conduct. The compliance officer will report directly to ------CORRECT ANSWER------- --------The managing physicians and board
How many components are required by the OIG to have an effective Compliance Program? ------CORRECT ANSWER--------------- 7 What will show a third party's good faith toward remediation? ------ CORRECT ANSWER---------------Compliance Program What is the Federal agency that provides compliance program guidance to providers and covered entities? ------CORRECT ANSWER---------------Office of Inspector General A clinical laboratory gets all of their Medicare patients to sign a blank ABN in case Medicare does not pay for a service. This is part of the clinic's written policy, therefore is in compliance Y/N ------CORRECT ANSWER----- ----------No, laboratory may never ask a patient to sign a blank ABN Can the government take back monies from a nursing facility for failure of a patient's care? ------CORRECT ANSWER---------------Yes, there is a direct link to quality of care and billing for services. Clinical Laboratories should charge physicians a price for ordered tests at ____________ ------CORRECT ANSWER---------------Fair Market Value Every third party health care company should designate someone to serve as the focal point for compliance activities. This position is called a ___________. ------CORRECT ANSWER---------------Compliance Coordinator.
penalties of up to how much per HIPAA privacy regulations violation. ------ CORRECT ANSWER---------------$50, Physicians sometimes own other health-related businesses, such as physical therapy facilities, CME or home health companies, diagnostic imaging centers, or laboratories. Because these businesses provide designated health services, what may be triggered? ------CORRECT ANSWER---------------Stark Which law increases the severity of penalties for violations involving organized crime? ------CORRECT ANSWER---------------RICO Act Which law provides for a civil monetary penalty (up to $15,000 per service) and exclusion from government programs in any case where a person submits an improper claim, which was know to have been, or should have been know to have been, provided through a prohibited referral, and has not refunded the payment? ------CORRECT ANSWER---------------Stark Which of these responsibilities is not one of a compliance officer? ------ CORRECT ANSWER---------------Create all policies and procedures What are key responsibilities of a compliance officer? ------CORRECT ANSWER---------------Ensure internal controls are capable of preventing and detecting significant instances or patterns of illegal, unethical or improper conduct. Monitor the performance of the practice's compliance program on an ongoing basis and take steps to improve effectiveness. Identify and assess areas of compliance risk.
What year did HITECH Act get implemented? ------CORRECT ANSWER---- ----------- 2009 What policy is important in dealing with employee concerns? ------ CORRECT ANSWER---------------Non-Retaliation policy When can a covered entity disclose PHI without a patient's consent? ------ CORRECT ANSWER---------------When providing in cases of suspected abuse. What covered entity as the most HIPAA breaches? ------CORRECT ANSWER---------------Business Associates How soon are practices or medical organizations required to process record requests? ------CORRECT ANSWER---------------Within 30 days What does HITECH stand for? ------CORRECT ANSWER---------------Health Information Technology for Economic and Clinical Health What safeguard is defined as measures to protect electronic systems? ------ CORRECT ANSWER---------------Physical safeguards
Physician must attest the medical benefits outweigh the risk of the transfer in writing To enroll in the CLIA program, laboratories must first register by completing an application, pay fees, be surveyed, and if applicable become what? ------ CORRECT ANSWER---------------Certified Under EMTALA a treating physician can consult other physicians in what ways that are not prohibited? ------CORRECT ANSWER--------------- Telephone Video Conferencing Internet Waived and PPM laboratories may apply directly for their certificate as they are not subject to _________? ------CORRECT ANSWER--------------- Routine inspections Which one of the following is not considered an engineering control? ------ CORRECT ANSWER---------------Safe medical devices What foreign language does OSHA mandate the OSHA poster be posted with at each medical facility? ------CORRECT ANSWER---------------No requirement but also available in Spanish
What could constitute an occupational exposure? ------CORRECT ANSWER---------------A needle stick A cut with a sharp object A percutaneous injury Why must an employer implement an Exposure Control Plan? ------ CORRECT ANSWER---------------To ensure proper employee protection measures Are compliance officers required to know all OSHA laws? ------CORRECT ANSWER---------------No, but they should know where to find the information What are the requirements for containers used to store waste? ------ CORRECT ANSWER---------------Container must be color-coded Why did OSHA publish a Blood Borne Pathogen standard? ------CORRECT ANSWER---------------Because of significant exposures to viruses and other microorganisms What employees should get Hep B vaccines? ------CORRECT ANSWER---- -----------Any employee exposed to blood borne pathogens If the main entrance cannot be made handicap accessible, then _______________ ------CORRECT ANSWER---------------People should be detoured to another entrance.
Should employees be allowed to download software? ------CORRECT ANSWER---------------Yes, as long as it is authorized If a state or federal agent arrives at your office and presents a search warrant, it is best practice to what? ------CORRECT ANSWER--------------- Contact your attorney immediately The HITECH Act revisions significantly increased the penalty amounts the Secretary may impose for violations of the HIPAA rules and encourage prompt _________? ------CORRECT ANSWER---------------Corrective action A search warrant, State or federal (or both) allows the agents the right to what? ------CORRECT ANSWER---------------to enter and seize documents Which office is mainly responsible to investigate health care fraud waste and abuse? ------CORRECT ANSWER---------------Office of Inspector General (OIG) When drafting audit protocol in an internal investigation it should be carefully worded and tied to the regulatory scope and applicability research. If an attorney doe snot draft the protocol, one should review it for language, Why? ------CORRECT ANSWER---------------For attorney client privilege. CMS relies on a number of program contractors to identify and respond to fraud, abuse, and improper payments in the Medicare and Medicaid programs. these contractors are charged with protecting the programs ____________. ------CORRECT ANSWER---------------Integrity
If an internal audit reveals issues, it's time to do some interviews and document reviews. How many people should be involved in the interview process of an employee? ------CORRECT ANSWER---------------2+ the attorney Free statistical software that can be used to select a random sample for audits is called what? ------CORRECT ANSWER---------------RAT-STATS When is it acceptable to bill an office visit based on time? ------CORRECT ANSWER---------------If over half of the visit is spent counseling the patient. Incident to rules can be complicated and present additional risks to a practice/organization. If a provider is available only via paper or telephone, incident-to billing _________________ ------CORRECT ANSWER------------- --Requirements are not met. Because it is considered the overarching criteria for determining a level of service, the provider must ensure that the documentation supports what? -- ----CORRECT ANSWER---------------Medical Necessity. Which screening exam does not require an order, in any setting? ------ CORRECT ANSWER---------------Mammogram In general, the OIG recommends auditing how many medical records per federal payer? ------CORRECT ANSWER---------------5 or more
