AAPC Certified Professional Compliance Officer (CPCO) Certification Practice Exam

These questions are part of the practice quiz. Start practicing

• Which program was established to address health care fraud specifically?
• What safeguards are described as measures that protect electronic systems?
• According to the OIG, what is one of the key elements of a robust compliance strategy?
• Under the Medicare Modernization Act, which aspect of healthcare billings was significantly influenced?
• Which department of the OIG provides mission and administrative support?
• What key component should not be disclosed according to HIPAA regulations without consent?
• How many states require nursing facilities to perform an FBI check on employees?
• Billing companies should avoid using which type of coding?
• What should be the ultimate goal of a compliance program within a healthcare organization?
• What immediate step should be taken after suspending an excluded employee?
• What is required for employee training on workplace hazards?
• Which two states have mandatory compliance program certification requirements?
• What is the maximum penalty a person may face for violating the anti-kickback statute?
• A physician who fails to respond after being called by another physician is in violation of which act?
• Which of the following statements is not true regarding the categorization of improper payments?
• Why is it critical for a practice to communicate its training policies effectively?
• What role does the Civil Rights Act play in personnel policies?
• How many days does a billing company have to notify authorities after credible evidence of fraud is discovered?
• What does the attorney-client privilege protect?
• What law is triggered when physicians own businesses providing designated health services?
• In the case of incident-to billing, what must be true for the requirements to be met regarding provider availability?
• Which statement is true regarding the creation of handicap parking spaces when there are 4 or fewer spaces?
• According to the OIG compliance program guidance, what is acknowledged as the first priority of a physician practice?
• Which act enhances penalties for violations related to organized crime?
• How many components must a Compliance Program have to be considered effective by the OIG?
• CMS program contractors are charged with protecting the integrity of which programs?
• Clinical laboratories should charge physicians for ordered tests at what price?
• What is the maximum civil monetary penalty per HIPAA privacy violation enforced by the Office of Civil Rights (OCR)?
• How many medical records does the OIG recommend auditing per federal payer?
• What action should be taken when it is discovered that an employee is excluded from federal programs?
• What constitutes a violation when paying rent to a hospital for office space?
• Which documentation guideline helps avoid overpayment demands in case of an audit?
• If the main entrance cannot be made handicap accessible, what should be done?
• Why is it essential for an employer to implement an Exposure Control Plan?
• What is not included in the hazard communications standard?
• If a practice uses an outsourced compliance officer, what does the OIG recommend?
• In ethical compliance, what is essential for fostering an open reporting environment?
• Which action is a compliance officer NOT typically responsible for?
• When did the Medicare Modernization Act (MMA) become law?
• What constitutes a violation of the Stark law?
• To improve employee engagement, what should employers focus on?
• What procedure must be followed when a patient's information is to be de-identified?
• What is a significant aspect of privacy rules according to HIPAA?
• Which office enforces HIPAA's privacy, security, and breach notification rules?
• Which law does not mandate nursing facilities to conduct state or Federal (FBI) criminal background checks?
• Which of the following is not an example of safety measures?
• Which type of time record keeping policy is not typically required?
• Which document is essential for adherence to HIPAA when using an outside compliance officer?
• What is one requirement for transferring an unstable patient under EMTALA?
• Which of the following should be included in the compliance program policy?
• What do compliance requirements often involve, aside from written policies?
• What is an example of complete elimination of all forms of microbial life?
• What payment structure do RAC auditors use?
• What is the main goal of a workplace safety program?
• What is referred to as attorney-client work product?
• What is a key compliance requirement outlined in the Patient Protection and Affordable Care Act (PPACA)?
• What information should be included on a lab's requisition form for tests ordered?
• What should be done if offenses are detected within a compliance program?
• What is the purpose of the supplemental compliance program guidance provided by the OIG?
• What defines an emergency medical condition?
• Can healthcare providers request additional time to supply records requested by an auditor?
• What is NOT required under anti-dumping statutes?
• According to the Medicare statute and regulations, what must entities determine regarding items or services billed to Medicare beneficiaries?
• What is a typical responsibility of a compliance officer in a healthcare setting?
• Audit MICs can audit a Medicaid provider throughout his or her __________.
• What enhances the chances of successfully implementing a compliance program, even if the compliance officer is not a lawyer?
• Which of the following statements is true regarding IRS, DOL, and PBGC?
• What quality is essential for a compliance officer or committee in an effective compliance program?
• Under EMTALA, which of the following methods can a treating physician use to consult with other physicians?
• What do employees have to report erroneous conduct without facing?
• What third-party health care provider is playing an increasingly vital role in the health care industry?
• Which of the following is a concern related to workplace safety in medical settings?
• What is the purpose of Modifier 25 in medical billing?
• HR policies need to be designed to meet what requirement?
• CLIA certificates remain valid for how many years?
• According to the OIG guidance, which types of errors can be prevented by incorporating their advice into policies?
• Which law regulates the relationships between competitors to promote fair competition?
• What is one of the main purposes of the HCFAC program?
• One of the responsibilities of CMS under the Medicaid Integrity Program is to:
• Which of the following limits the number of medical records that can be requested from a solo practitioner?
• What is the level 3 of the RAC claims appeal process?
• What typically occurs next when settlement negotiations are unsuccessful?
• Why is it important for MFCUs to employ attorneys?
• What timeframe is an employer required to post the OSHA 300 log?
• What kind of agreements does the Anti-kickback law particularly scrutinize?
• Under what condition is it acceptable for employees to download software?
• Why is it important for the compliance officer to coordinate and screen employees, agents, and independent contractors?
• Which of the following is part of the criteria for a safe transfer of an unstable patient?
• What determines exposure in a workplace?
• What is the consequence of a physician not signing a participating agreement with Medicare?
• What is a primary function of Medicaid Fraud Control Units (MFCUs)?
• What is one key aspect of the Fraud Prevention System (FPS)?
• To enroll in the CLIA program, what must laboratories achieve after registering and paying fees?
• What is the term for health information that does not identify an individual?
• What is the typical duration of a Corporate Integrity Agreement (CIA)?
• What should an organization establish to effectively respond to workplace incidents?
• What is the recommended timeframe for conducting a performance review?
• What must happen for a patient to revoke their authorization for PHI release?
• What do MAC's administer for Medicare Services?
• What aspect of an internal investigation must be carefully worded and tied back to regulatory standards?
• Which statement regarding communication in legal matters is accurate?
• When should ABNs be presented to patients?
• Which of the following is NOT considered an administrative sanction?
• What does ERISA stand for?
• In what year did Franklin D. Roosevelt sign Social Security into law?
• Which type of laboratory certification is specifically designed for lower-risk testing environments?
• A basic concept in the anti-kickback safe harbors and Stark exceptions is that financial transactions must be conducted under what condition?
• Which of the following is a requirement of a compliance officer within a medical practice?
• What is one common consequence of non-compliance in a medical practice?
• Which law provides for a civil monetary penalty (up to $15,000 per service) for improper claims related to prohibited referrals?
• What type of services does Medicare Part D cover?
• Who provides funding for CLIA?
• What is the main purpose of EMTALA?
• In which year did the OIG publish hospital compliance guidance?
• What do compliance officers need to keep track of when investigating potential misconduct?
• When can patients instruct their provider not to share information with their health plan?
• The nationwide network of MACs dates back to which year?
• Which third-party entity is uniquely positioned to discover fraud in healthcare?
• The penalty amount for violating EMTALA can reach how much for hospitals?
• Under EMTALA, what is the primary obligation of Medicare participating hospitals regarding patients who arrive at the emergency department?
• The guidance from OIG can be incorporated into policies to prevent which types of errors?
• Which of the following statements is correct about documentation reviews during an internal investigation?
• What is the maximum civil monetary penalty that the Office of Civil Rights (OCR) can impose for HIPAA violations due to willful neglect?
• How is Medicare fraud defined?
• Who is responsible for enforcing HIPAA Privacy and Security Rule provisions?
• What is one of the primary functions of ZPICs?
• A pertinent component of an effective compliance program includes what important aspect?
• Which form must be signed by the patient if providers believe that Medicare will not cover the services?
• Why is it important for compliance programs to be customized?
• What role do ZPICs play in the context of Medicare and Medicaid?
• What should compliance officers obtain from employees, in addition to keeping a training log and records?
• For how long does the OIG require documentation relating to the CIA to be kept after the CIA term?
• What role does the OIG serve regarding Medicare and Medicaid services?
• Which of the following is a necessary component of a compliance program according to the OIG?
• Which Federal department considers self-reporting of misconduct a mitigating factor?
• Under what circumstance can a covered entity disclose PHI without obtaining patient consent?
• In what year was the ADA amendment enacted?
• What are the key functions of the compliance officer regarding the compliance program?
• Are compliance officers required to know all OSHA laws?
• How often does the OIG submit its semi-annual report?
• What needs to be documented before transferring an unstable patient according to EMTALA?
• How does a compliance program help protect patient privacy?
• What is the consequence for a physician who fails to respond to an emergency situation when on call?
• What percentage of its resources does OIG dedicate to Medicare and Medicaid?
• What is NOT a responsibility of Zone Program Integrity Contractors (ZPICs)?
• What two laws primarily govern the relationships between referral sources, such as physicians and hospitals?
• What must the provider ensure supports medical necessity when determining a level of service?
• The CLIA regulations emphasize that the more complex a test is, the __________?
• The initiation of the Comprehensive Error Rate Testing Program (CERT) was aimed at what purpose?
• Which organization is responsible for providing analysis, research, and technical assistance regarding CLIA?
• Compliance programs help organizations comply with what regulations?
• Which office is primarily responsible for investigating health care fraud, waste, and abuse?
• Can an employee transfer a chemical to another container legally?
• Which of the following would be considered a violation of anti-kickback statutes?
• What is the focus of ZPIC’s audits?
• What is the primary role of the Office for Civil Rights (OCR)?
• What specific information is required on all CMS-1500 forms for laboratory billing?
• OIG integrity agreements are often a catalyst for change in what aspect of an organization?
• In the context of compliance, what is HCFAC's main focus?
• What should be designated in third-party health care audits to address a company's concerns?
• When drafting audit protocols for an internal investigation, why is it important to have an attorney review the document?
• What is a serious danger for compliance programs?
• A majority of the OIG's resources are dedicated to oversight of which programs?
• During an internal investigation, what must an employee know if their interview is conducted by an attorney?
• When should a third-party health care company start a compliance program?
• What documentation is mandated for each patient seen in the emergency department?
• What condition must be met for a patient in the emergency department to be transferred to another hospital without violating EMTALA?
• What resource should be readily accessible to all coding staff?
• A billing company's written policies and procedures should reflect current ________.
• What is one of the main responsibilities of the CMS regional office?
• After identifying and prioritizing risks, what is the next step in the risk assessment process?
• Which party may be held liable under the False Claims Act?
• What does RAT-STATS refer to?
• What does the OIG acknowledge about the implementation of compliance programs in physician practices?
• When a group practice utilizes a billing agent, what type of payment arrangement is necessary for Medicare billing?
• What does the acronym LEP stand for?
• Which third party is essential for ensuring accurate billing and reimbursement?
• The 250-yard zone rule does not apply to which of the following?
• What legal framework defines and limits how an individual’s PHI may be used or disclosed?
• Once a vulnerability has been identified, what factor is crucial in determining its risk rating?
• When establishing a compliance plan, what does the OIG recommend a billing company take?
• What should be done if an employee encounters a contaminated sharp object?
• What penalty can be imposed for false claims filed under the FCA?
• Medicaid Fraud Control Units (MFCUs) operate under the direction of which entity?
• What is an essential component for the lawful behavior and success of nursing facilities?
• What is one type of benefit included in Welfare Benefit plans?
• For what purpose can medically unnecessary services be billed to Medicare?
• Which safe harbor can protect physician independent contractor agreements with hospitals or providers?
• What term describes when an organization offers incentives for referrals?
• What occurs when the OIG waives its exclusion authority concurrent with resolution of monetary liability?
• What document does the OIG provide to keep Congress informed about significant findings?
• What type of services are generally considered non-covered for Medicare patients during routine screening?
• The OIG's report to Congress is known as what?
• Who is primarily responsible for focusing on key risk areas through education and documented audit improvement?
• What else should third parties integrate into their compliance programs besides policies and procedures?
• Which of the following is a consequence of pursuing recipient fraud?
• Which OIG component is instrumental in ensuring compliance with health care laws and regulations?
• Under the Civil Monetary Penalties (CMP) law, what did HIPAA increase regarding penalties for false claims?
• What should providers be aware of when dealing with Medicare claims?
• What year was the Patient Protection and Affordable Care Act (PPACA) enacted?
• When can an office visit be billed based on time?
• What type of laboratories apply directly for their CLIA certificate and are not subject to routine inspections?
• If quality concerns arise in a billing profile investigation, which organization may be involved?
• Under which circumstance does a standard boilerplate clause in a CIA allow the OIG to inspect a provider's business?
• If the billing manager reports an increase in correspondence challenging the medical necessity of claims, what should the compliance officer do next?
• Which employees do not fall under Category I in a medical facility?
• Medical practices should establish policies and procedures for what to manage past identified risks?
• What action does the HITECH Act revisions encourage following HIPAA violations?
• What aspect of medical billing does Modifier 25 specifically address?
• Which organization is responsible for publishing CLIA rules and regulations?
• What is a crucial responsibility of the compliance officer when managing incidents and investigations?
• What is an example of a corrective action resulting from an audit?
• RACs perform what type of review(s)?
• Which of the following is not true regarding Audit MIC?
• Which of the following is considered a business associate in the context of healthcare?
• What do LCDs and NCDs limit coverage to?
• What is essential for enforcing and disciplining individuals who violate compliance standards?
• What was the compliance deadline for all covered entities under the HIPAA Omnibus Rules?
• In the context of healthcare, what does the term "Disclosure" refer to?
• Within how many days must changes in ownership be reported to the Medicare program?
• Which criterion defines a new patient in relation to professional services received?
• What should a compliance officer do if a compliance problem is detected too slowly?
• Alerts regarding expired certificates from Medicare will lead to what consequence for physician's office labs?
• What term describes the arrangement where Accountable Care Organizations share gains and losses among providers?
• What procedure would require the use of high-level disinfection?
• The OPPS rule requires hospitals to include all OPPS services on the same claim for what reason?
• What is a best practice method for anonymous reporting of non-compliance issues?
• How many years must providers keep records of disclosures made?
• What accurately describes Zone Program Integrity Contractors (ZPICs)?
• How should policies evolve in a medical facility?
• Who bears the responsibility for developing and maintaining compliance programs?
• In what year did the GAO identify Medicare claims as high risk for fraud and abuse?
• Approximately how many percutaneous injuries involving contaminated sharps occur annually?
• What defines fraudulent billing in the context of healthcare?
• What authority has CMS contractors been given?
• When was the supplemental compliance guidance for hospitals published?
• What is a requirement on all CMS-1500 forms used for laboratory testing?
• In which circumstance do office notes require special security measures?
• According to Inspector General Daniel Levinson, what can alleviate enforcement actions from a CIA to a CCA?
• According to Medicare program manual instructions, overpayments are generally returned to what entity?
• What addresses compensation paid by laboratories to referring physicians for blood specimen services?
• Can CMS take back payments without reviewing a patient record?
• In which aspect of healthcare does the CMS play a critical role?
• How many states currently mandate nursing facilities to perform a background check of state records for direct-access employees?
• What is the maximum duration an employee can take off during an approved FMLA leave?
• In the context of Medicare billing, who is responsible for ensuring that claims are rightfully submitted?
• What is considered a significant factor in incidents of fraud, waste, and abuse in healthcare?
• In what year did OSHA publish the Bloodborne Pathogens standard?
• Which of the following is NOT one of the seven elements of an effective compliance program as stated by the OIG?
• Under which circumstance may a doctor disclose PHI without patient consent?
• During compliance training, which topic is essential to cover?
• When it comes to the participation of a student in billable services, which aspect can they perform without the physical presence of a teaching physician?
• True or False: Medicare has a Part E.
• What are the established categories of tests under CLIA based on test complexity?
• What is the name of the free statistical software used for selecting a random sample for audits?
• If a person collapses outside the ER doors, does EMTALA apply?
• What is considered inappropriate in healthcare billing practices?
• How many months of health coverage does COBRA provide after employment ends?
• What is considered the most significant state program for healthcare?
• Should laboratories develop standards of conduct for their employees?
• The effectiveness of which component of a compliance program is evaluated through regular audits?
• What are key risk areas defined for medical billing companies?
• What does PHI stand for in terms of health information privacy?
• How many days does a medical billing company have to send provider determinations?
• What must hospitals ensure regarding patients in the emergency department under EMTALA?
• Which of the following is a role of billing agencies in healthcare?
• Which employees should receive Hepatitis B vaccines?
• What is the primary responsibility of program contractors in relation to Medicare and Medicaid programs?
• What should be included in an audit report for negotiation regarding overpayments and underpayments?
• The Medicare Modernization Act (MMA) of 2003 primarily supported which of the following?
• What impact did the HIPAA Omnibus Rule have on business associates?
• In a qui tam action, what percentage of the settlement is the relator entitled to receive?
• Which department is closely related to compliance issues?
• What is an area that should be monitored and may require policy measures to prevent recurrence?
• What is a primary goal of a compliance program?
• Which office within the OIG is responsible for conducting investigations related to fraud and misconduct?
• If a provider does not bill Medicare or Medicaid, what is still required?
• Medicare Part B primarily pays for which type of services?
• What is a compliance officer's obligation regarding the follow-up actions for non-compliance?
• How many agencies are responsible for overseeing ERISA?
• What must a billing company's written policies and procedures reflect?
• According to the Patient Protection and Affordable Care Act of 2010 (ACA), what condition must providers meet regarding compliance plans?
• What type of injury can be classified as an occupational exposure?
• One benefit of having an effective compliance program is that it demonstrates what to the practice?
• What is the maximum annual value of gifts and benefits that physicians can receive from providers, adjusted for inflation?
• Are OIG guidelines for compliance programs mandated for third-party health care companies?
• What is the maximum fee an employer can charge employees for personal protective equipment?
• Which safeguard is essential for protecting patient health information during electronic transmission?
• Which Code of Federal Regulation section is significant for Compliance Officers?
• What type of entity experiences the greatest number of HIPAA breaches?
• What should a provider do if a physician exceeds the allowable amount of gifts and benefits?
• What is the role designated to oversee compliance activities in a third-party health care company?
• In review practices, what is an important benefit of feedback?
• What constitutes a violation of the Civil Monetary Penalties law?
• What is the civil monetary penalty for submitting an improper claim due to a prohibited referral under the Stark law?
• What establishes the Medicare Integrity Program?
• In what situation can PHI not be disclosed without a patient's consent?
• What is the primary objective of PATH (Physician at Teaching Hospitals) audits?
• What should healthcare providers do to ensure compliance with privacy regulations?
• To ensure compliance of standing orders, what should the compliance officer implement?
• If a facility is only drawing blood, is a CLIA number required?
• What are the mission statement and purpose of a healthcare organization also known as?
• How many medical records does the OIG recommend auditing per federal payer?
• A community call program can satisfy hospital obligations for on-call coverage according to which entity?
• In an internal investigation, what is critical for employees to understand regarding documentation?
• The OIG's description of effective compliance program components is based on what guidelines?
• What primary function is associated with the OIG in relation to Medicare programs?
• There has been an increased national focus on which aspect of healthcare?
• Under the False Claims Act, who can file a civil action for healthcare fraud?
• The Office of Inspector General (OIG) operates within which federal agency?
• What should a compliance officer primarily focus on to ensure effective compliance?
• What should not delay the screening process when a patient presents to an ER?
• What must CMS regional offices comply with in terms of reporting?
• One critical element of an effective compliance program is a compliance office or committee that is:
• What are the penalties under the False Claims Act (FCA) for filing a false claim?
• What is the penalty range for each false claim filed under the False Claims Act?
• According to the OIG, what can an effective compliance program promote?
• A qui tam complaint is initially sealed for how many days?
• Is it acceptable for practices to remind patients of their upcoming appointments?
• What type of outreach does OSHA engage in to enhance workplace safety?
• What law was enacted to promote health information technology and improve healthcare quality?
• What is a key concept of the Privacy Rule?
• True or False: Exempt employees must be paid overtime.
• When does an employee's declination of the Hepatitis B vaccine expire?
• Which type of errors are compliance programs primarily designed to prevent?
• Why did OSHA publish a Blood Borne Pathogen standard?
• The Comprehensive Error Rate Testing Program (CERT) was initiated in which year?
• What role does OSHA play beyond enforcement of standards?
• Which of the following represents a key aspect of Human Resources in compliance?
• What does attorney-client privilege protect?
• Which certificate allows a laboratory to conduct moderate- to high-complexity laboratory testing temporarily?
• What is the term for the shared arrangement in an ACO for gains and losses among members for certain Medicare beneficiaries?
• Which action can potentially decrease the risk of fraud in healthcare services?
• What is the primary purpose of monitoring programs for fraud, waste, and abuse?
• What is the term used when a hospital sends a patient home or transfers them without providing care?
• What steps should a billing company take if they identify credible evidence of provider misconduct?
• What must a billing company do immediately after determining there is credible evidence of fraud?
• When can an employer do a drug screen on employees?
• What can providers review to better understand the compliance requirements of a clinical lab?
• What should employees do if questioned during an investigation?
• Which of the following is a method OSHA uses to promote workplace safety?
• Which of the following best describes the approach of a compliance program?
• Which organization provides opinions regarding Stark law?
• For a small physician group practice, what is an appropriate starting point for an effective compliance program?
• What kind of policy is implemented to encourage open communication within a healthcare practice?
• What does ZPIC stand for in the context of auditing for Medicare?
• In what language does OSHA mandate the posting of its poster in medical facilities?
• What time frame is designated for updating the Medicare program about ownership changes?
• What does an internal audit typically include if issues are found?
• How does CMS categorize improper payments?
• What should a compliance officer do after an audit reveals areas for improvement?
• For the establishment of compliance in healthcare, what significant legislation was signed in 1935?
• How do nursing facilities typically accomplish compliance?
• According to the privacy rule, how long must a practice retain medical records?
• What does CCA stand for in the context of compliance programs?
• What is an important responsibility of supervisors regarding workplace safety?
• Under the Stark law, penalties can be imposed for improper claims submitted through what type of referral?
• How many regional offices does CMS have?
• Improper advertising may lead to consequences from which authority?
• If a provider is only available via paper or telephone, what is true about incident-to billing?
• Why is the annual OIG Work Plan critical for compliance officers during risk assessments?
• Does a provider who conducts only waived tests need to obtain a CLIA number?
• To prevent a conflict of interest, who should the compliance officer not report directly to?
• How many regional offices does CMS have across the country?
• How many years can RACs look back from the date of service?
• When should an interview take place during an internal investigation?
• Skilled nursing facilities provide extended skilled nursing or rehab care under Medicare Part _______.
• Which department is responsible for monitoring and recertifying Medicaid Fraud Control Units (MFCUs)?
• Which act authorized imposing civil monetary penalties against healthcare providers employing excluded individuals?
• Which key source of information should compliance officers utilize during a risk assessment?
• Who has the authority to revise and enforce compliance protocols within a healthcare organization?
• If an employer does not meet requirements for FMLA, what should they still implement?
• What type of audit is conducted to identify current compliance and areas of non-compliance within the entire organization?
• Which office was created to combat waste, fraud, and abuse in federal healthcare programs?
• Which office is typically involved in whistleblower actions and significant investigations?
• If no provider is present at a physician's office when a patient with an acute issue presents, how is this viewed under EMTALA?
• What is the purpose of a Non-Retaliation policy in the workplace?
• To whom does the compliance officer report directly?
• During an internal investigation, what is the next step after researching regulatory scope and applicability?
• Which statute may be implicated by percentage arrangements in billing companies that provide marketing services?
• What is a crucial step in establishing a compliance program within a healthcare organization?
• A high-level statement or plan that outlines an organization's beliefs, goals, and acceptable procedures is called what?
• What department monitors the MACs?
• What allows for a reduction in penalties if a violation is voluntarily disclosed and cooperation is demonstrated?
• What is the required time frame for practices or medical organizations to process record requests?
• What are the requirements for containers used to store waste?
• If a practice has identified a provider as an outlier, what is critical to verify regarding the billed services?
• What is the primary function of the Office of Audit Services within the OIG?
• After the enactment of CLIA, what percentage did the total number of quality deficiencies decrease by from the first to the second laboratory survey?
• In an internal audit, how many people should ideally conduct interviews with a single employee?
• Should compliance programs be uniform across all healthcare organizations?
• What should a practice do when scheduling an appointment for a referred patient with a hearing deficit?
• Which responsibility is NOT typically associated with a compliance officer?
• What is the primary mission of the Office of Inspector General (OIG)?
• What is one of the benefits of having a compliance program?
• Which aspect would not typically be considered during a performance review?
• What does PAR stand for in the context of Medicare claims?
• What is the aim of technical safeguards in HIPAA compliance?
• In the context of billing, what is essential for accuracy and reimbursement?
• Who primarily oversees issues related to the anti-kickback statute?
• Which type of expense related to developing a compliance program is not tax deductible?
• Which type of errors is primarily targeted by OIG's guidance?
• Are providers allowed to ignore an auditor's request for records?
• Which OIG component conducts audits aimed at reducing waste and mismanagement?
• Which safeguard involves training and managing the workforce in relation to ePHI?
• What key standards were established by Congress in 1988 concerning laboratory testing?
• What is a key responsibility of employees regarding the Compliance Program?
• Why is it important for compliance officers to have established disciplinary policies for non-compliance?
• Private or government investigations often begin with a request for what?
• If a patient collapses outside the ER doors, does EMTALA apply?
• If a state or federal agent arrives at your office with a search warrant, what is the best practice?
• How often should the compliance program be monitored and updated?
• What federal agency is CMS a division of?
• How is the compliance program characterized in relation to the changing nature of healthcare regulation?
• How often does the OIG suggest larger physician practices report compliance activities to the board of directors?
• What is the common name for Form CMS-R-131?
• What should an employee be informed about during an internal audit interview by an attorney?
• How many regions are designated for the Medicaid Fraud Control Unit?
• In the context of an internal audit, how many people should typically be involved in the interview process of an employee?
• What areas do CMS regional offices primarily focus on?
• Can CMS recover payments without checking a patient's medical record?
• How many days does Medicare require for physician certification of the need for physical, occupational, or speech therapy to be completed after therapy begins?
• Penalties under the False Claims Act (FCA) include what additional charges?
• Which screening exam does not require an order in any setting?
• Which role is specifically designated within an effective compliance program?
• Which of the following is included in designated health services?
• Which organization provides advisory opinions on the anti-kickback law?
• What type of software do third-party agencies use to identify claims aberrations?
• A search warrant allows agents the right to do what?
• Some of the largest breaches reported to HHS have involved which parties?
• According to the OIG, after initial education and training, when is a benchmark audit recommended to be performed?
• What is a primary safety concern in the medical setting?
• A patient with an asthma attack at a physician's office without a provider must go to the ER. Is this a violation of EMTALA?
• What does EAP stand for?
• One responsibility of the compliance officer involves ensuring the implementation of what type of program?
• How can penalties under the False Claims Act be mitigated upon disclosure of a violation?
• What should be the primary focus of an organization's compliance program?
• What does the term "Business Associate" refer to in HIPAA compliance?
• After identifying and prioritizing risks in a compliance program, what is the next step for compliance officers?
• What type of testing requires a provider to have a CLIA number?
• Besides policies and procedures, what other items are important for third parties to integrate into their compliance program?
• What aspect of compliance is critical for third parties to monitor?
• What is required of any laboratory performing testing on human specimens?
• What action will Medicare take if alerted about an expired certificate in a physician's office lab?
• What restriction exists for employees with a criminal conviction related to healthcare as per the Code of Conduct?
• What must employees know when there is notice of an investigation?
• What is a key function of OSHA?
• Under the qui tam provisions, what can a relator gain from successfully bringing a case?
• What does failure to respond quickly to suspected non-compliance threaten?
• In what year was the Civil Rights Act implemented?
• What should be the immediate action taken when an employee is found to be excluded from government programs?
• Which of the following is a requirement for MFCUs?
• A review and analysis of all the applicable documents in a specific area is referred to as what type of audit?
• What does IRO stand for in the context of Corporate Integrity Agreements (CIsAs)?
• What is true about automated reviews conducted by RACs?
• What is the best method for ensuring all employees understand the directive regarding attendance at required training sessions?
• Which policy is essential for addressing employee concerns in an organization?
• A compliance program's design is intended to help organizations achieve their stated goals. What term best describes this?
• What do providers review to understand the compliance requirements of a clinical lab?
• What is considered the most important aspect of a compliance program?
• What are the limits of auditor record requests for large groups with 16 or more individuals?
• What is one of the primary roles of Medicaid Fraud Control Units (MFCUs)?
• What could be considered an occupational exposure?
• True or False: Hourly employees must be paid overtime per federal law.
• What is OSHA?
• What can result in imprisonment and penalties for providers and covered entities?
• To enroll in the CLIA program, what are laboratories required to do first?
• What is an OSHA 300 form used for?
• Should American taxpayers be concerned about Medicaid fraud?
• In emergency situations under EMTALA, how should a physician prioritize patient care when consulting?
• What is one of the risks for physicians repeated gross violations of EMTALA?
• In which context would you most likely see Independent Review Organizations (IROs)?
• What aspect do EAPs primarily address?
• Which type of safeguard includes maintaining security measures to protect electronic Protected Health Information (ePHI)?
• Under EMTALA, if a patient is stable, which of the following would least affect the decision to transfer them?
• What is the recommended timeframe for conducting a performance review?
• If a compliance officer has questions regarding discrimination in healthcare programs, which office should they contact?
• What should an employer never tolerate in the workplace?
• Why is understanding third-party billing critical in healthcare compliance?
• What is the term of a Compliance Investigation Agreement (CIA)?
• Who is tasked with conducting laboratory quality improvements for CLIA?
• What is the financial penalty for submitting false claims under the FCA?
• What must a Personnel Policy Manual adhere to?
• What is the term for the plan that addresses areas of non-compliance identified by the compliance officer?
• Which of the following describes the role of a liaison between the practice and an outsourced compliance officer?
• What is a key responsibility of a compliance officer?
• The role of a compliance officer in a healthcare setting primarily revolves around:
• What type of training does OSHA provide to workers?
• Which statute may be violated by certain joint ventures in healthcare?
• When a physician signs a participating agreement with Medicare, they agree to what kind of payment?
• Is hourly employee overtime pay dictated by state or federal law?
• Which act established labor regulations overseen by the Department of Labor?
• Should providers learn about Medicare guidelines?
• HHS, CMS, and the OIG publish regulations in which official publication?
• What is required for the release of Protected Health Information (PHI) in emergency situations?
• What does the acronym OIG stand for?
• What should be the first step taken by a billing company upon discovering credible evidence of fraudulent or abusive conduct?
• Which of the following is NOT a part of Medicare?
• Which two states have mandatory compliance program certification requirements?
• Which of the following is an objective of a QIO?
• Under HITECH revisions, which violations saw increased penalties?
• What will demonstrate a third party’s good faith towards remediation?
• Which of the following is not considered an example of sexual harassment?
• What type of authorization is required for the release of PHI?
• How many employees must an employer have to be subject to FMLA policies?
• What is one limitation of Medicaid Fraud Control Units (MFCUs)?
• Who is responsible for the oversight of the Medicare and Medicaid Programs?
• What is the primary purpose of a Corporate Integrity Agreement?
• Which law governs relationships between competitors in healthcare?
• What overarching goal do the Stark and Anti-kickback laws aim to achieve?
• The bulk of federal regulations in 42 CFR part 4 covers which programs?
• In cases of potential criminal violations, what is the recommended immediate action for a practice?
• Once risks are identified, what is the subsequent step for a compliance officer?
• What is a participating hospital required to maintain regarding individuals who seek assistance in the emergency department?
• What is the maximum civil monetary penalty for hospitals exceeding 100 beds that violate EMTALA?
• Which of the following is not considered an engineering control?
• According to the CMS website, who is subjected to Recovery Audit Contractor (RAC) audits?
• Which of the following is not a method to protect ePHI?
• What is one way to discourage whistleblowers effectively?
• Can a billing company’s compliance officer collaborate with provider offices?
• FERA expands the grounds for liability under which act?
• What is the process that assesses the effectiveness of the compliance program?
• What is the purpose of safety data sheets (SDS)?
• Why is it important for employees to understand their roles in the Compliance Program?
• Which is considered the most crucial aspect of a compliance program?
• How often should providers check if employees are on the OIG list of excluded individuals after hiring?
• PHI can be disclosed without patient authorization for what purposes?
• What does FPS stand for in the context of fraud prevention in healthcare?
• Compliance officers conduct audits primarily to identify which of the following?
• What comprehensive program was established by HIPAA to combat fraud against health plans?
• What type of agreement often includes provisions for OIG oversight?
• Which type of software process is typically used to identify potential claim errors?
• According to best practice guidelines, what should skilled nursing facility compliance officers do if an audit reveals claims did not meet medical necessity?
• Under whose direction does the HCFAC operate?
• Waived and PPM laboratories can apply directly for their certificate because they are not subject to what?
• What is the term for the initial review of all areas of possible non-compliance within a practice?
• Why wouldn't a medical facility need an ionizing radiation policy?
• A certificate of provider-performed microscopy (PPM) is issued to laboratories that:
• What does MAC stand for in a healthcare context?
• How can a hospital fulfill its on-call coverage obligations according to HHS?
• If a physician is found in violation of EMTALA, what consequence might they face?
• What area is of concern when patients are referred to home health agencies and/or DME suppliers?
• What is the underlying principle of the Equal Employment Opportunity law?
• What is a vital component of the compliance officer's role in managing investigations?
• What does the acronym HITECH stand for?
• Which organization provides advisory opinions on the anti-kickback law?
• Which component of the OIG is responsible for operating the OIG hotline?
• What must all medical facilities ensure for people with disabilities?
• Which federal department oversees Medicare and Medicaid policy?
• In what year did the Medicare learning network (MLN) begin?
• Which of the following is NOT a common method by which providers attempt to commit Medicaid fraud?
• In what year was the HITECH Act implemented?
• Physicians must report changes in their name and taxpayer ID within how many days?
• When would an employer need to complete an OSHA 300 form?
• Which office provides guidance in the healthcare industry through Advisory Opinions and Compliance Program Guidance?
• What element is a requirement for third-party billing?
• When establishing a compliance plan, what does the OIG recommend a billing company take?
• What fundamental concept does the attorney-client privilege support in legal practice?
• Why is it essential to review audit protocol language in an internal investigation?
• Can patients request amendments to their PHI according to HIPAA regulations?
• What is the primary purpose of sterilization in a medical setting?
• What is the typical term of a Certification of Compliance Agreement (CCA)?
• Which of the following is a requirement for processing endoscopes?
• Is a physician office in violation of EMTALA if a patient with an asthma attack has to go to the Emergency department for treatment?
• Which enforcement action indicates a serious compliance issue within healthcare practices?
• What is the maximum penalty for mail fraud?
• What does the medical benefits attestation by a physician need to include before transferring a patient under EMTALA?
• Which function do ZPICs NOT perform?
• Under what circumstances can employees report misconduct according to the Compliance Program?
• What rights do patients have when paying cash for services?
• How was OSHA established to ensure safe and healthy conditions for workers?
• What was the focus of the first compliance program guidance issued by the OIG in February 1998?
• What primarily distinguishes ZPIC audits from other Medicare audits?
• Which outcome is NOT a goal of a compliance program?
• What should be done when a compliance program finds discrepancies in claims?
• What is the primary focus of data mining techniques used by third-party agencies?
• Waiving Medicare deductibles or copayments is a violation of which statute?
• Why is it important for nursing facilities to track patient outcomes?