CPCO Compliance Officer case studies
CPCO Compliance Officer · Put your knowledge to work in context.
The Certified Professional Compliance Officer (CPCO™) is a credential listed by AAPC among its specialty certifications, alongside the CPB™, CPMA®, CDEO®, and CPPM® credentials. It sits in AAPC's healthcare compliance track, one of the professional areas the organization names for people working in the business of healthcare. The CPCO Compliance Officer case studies are 5 cases and about 4,369 words.
1Per-Referral Payments to a Physician-Owned DME Supplier
You are the compliance officer for a 14-physician orthopedic group. Nine days ago an anonymous hotline report alleged that the group's former office manager negotiated an arrangement with a nearby durable medical equipment (DME) supplier: the supplier paid the group 75 for every patient referred for a knee brace, invoiced as 'marketing support.' Physicians referred 212 patients over 14 months, and records show 16,400 was received before the payments stopped.
877 words, about 4 min2The Probe Sample With the Auto-Populated Review of Systems
You are the newly hired compliance auditor for a six-provider family medicine practice that grosses about $4.2 million a year and has never been audited by a payer. You pull a random sample of 30 established-patient visits billed 99213 or 99214 from last quarter.
856 words, about 4 min3Debridement Depth and a Modifier 25 on an Unsubmitted Claim
A 58-year-old patient with type 2 diabetes and peripheral arterial disease presents to the wound care clinic with a 12 cm² necrotic ulcer on the left heel. The physician documents: 'Extensive debridement of necrotic tissue with scalpel and curette; wound now 10 cm²; viable tissue at base; no bone palpable; no probe to bone.' The note never states whether muscle or fascia was debrided.
840 words, about 4 min4Modifier 26 Applied to Global Echocardiograms, and One Error Running the Other Way
A 22-physician cardiology group performs echocardiograms in its own office with its own machines and sonographers and interprets them itself; it also reads hospital-performed studies for the professional component only. In February a new billing vendor took over submission.
845 words, about 4 min5Telehealth After the Public Health Emergency: Place of Service, Audio-Only, and Licensure
A 40-clinician behavioral health group has delivered telehealth since 2020. During the public health emergency it billed psychotherapy visits with place-of-service 02 and modifier 95, and it treated audio-only visits as billable.
951 words, about 5 min