CPCO Certification Exam| Questions and Verified Answers| 2023/ 2024 Latest Update!!!
QUESTION
Which of the following settings is the incident-to rule not... [Show More] applicable?
A. Hospital
B. Solo-Physician office
C. Group Practice
D. Multi-Disciplinary Group Practice
Answer:
A. Hospital
QUESTION
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 amounts from the beneficiary, his/her other insurance, or anyone else.
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.
D
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.
QUESTION
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 office space is considered not to be a compensation arrangement under certain conditions and as such are considered exceptions as long as which of the following exists?
A. The lease would be commercially reasonable even if no referrals were made between the parties and has a term or rental or lease for at least one 1 year.
B. The lease provides for a term of rental or lease for at least 1 year
C. The space rented or leased does not exceed that which is reasonable and necessary for the legitimate business purposes of the lease or rental and is used exclusively by the lessee when being used by the lessee
D. The rental charges over the term of the lease are set in advance, are consistent with fair market value, and are not determined in a manner that takes into account the volume or value of any referrals or other business generated between the parties
E. All of the above
Answer:
E. All of the above
QUESTION
According to the Federal Register, the OIG has listed a number of potential risk areas for physician practices. These risk areas include: (a) coding and billing, (b) reasonable and necessary services, and (c) documentation. Which of the following scenarios would be considered a risk area or areas for a physician practice?
A. Dr. Y bills Medicare using a covered office visit code when the actual service was a non-covered annual physical. This could be considered improper coding or billing and therefore is considered a risk area.
B. Dr. X bills Medicare using a CPT surgical code including dressings and instruments for a minor procedure in which dressings and instruments are included in a single fee. This could be considered improper coding or billing and therefore is considered a risk area.
C. Dr. Z bills Medicare for a preventive medicine service code when the actual service was a non-covered annual physical. This could be considered improper coding or billing and therefore is considered a risk area.
D. Dr. T bills Medicare with a modifier, as defined by the CPT manual, to indicate that a service or procedure which has been performed has been altered. This could be considered improper c
Answer:
A. Dr. Y bills Medicare using a covered office visit code when the actual service was a non-covered annual physical. This could be considered improper coding or billing and therefore is considered a risk area.
QUESTION
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
Answer:
D. All of the above
QUESTION
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 orthopedic care to the community. [Show Less]
