HCCA CHC EXAM STUDY GUIDE
2026/2027 ACCURATE QUESTIONS WITH
CORRECT DETAILED SOLUTIONS ||
100% GUARANTEED PASS
<NEWEST VERSION>
1. Stark or Physician Self-Referral Law - ANSWER ✔ The Omnibus Budget
Reconciliation Act bans physicians from referring patients to receive
"designated health services" to any entity with which the physician has a
financial relationship. Designated health services include lab testing,
imaging services, physical or occupational therapy, etc. (civil only,
medicare/medicaid only, strict liability)
2. Anti-Kickback Statute (AKS) - ANSWER ✔ Prohibits the solicitation,
receiving, offering, or paying any remuneration directly or indirectly in cash
or in kind in exchange. Essentially it prohibits the exchange of anything of
value in exchange for or in an effort to gain the referral of business
reimbursable by federal healthcare programs. (intent, any federal program,
civil or criminal)
3. Physician Payments Sunshine Act (PPSA) - ANSWER ✔ Requires that
detailed information about payments or other "transfers of value" worth over
$10 from manufacturers of drugs, medical devices and biologics to
physicians and teaching hospitals be made available to the public. (Open
payment data).
4. Deficit Reduction Act - ANSWER ✔ A Federal law that grants states the
ability to modify their Medicaid programs. This allows individual states to
reform their Medicaid programs to fit with the present health care
environment while maintaining federal guidelines.
5. False Claims Act - ANSWER ✔ Originally adopted byt U.S. Congress to
discourage suppliers from overcharging the government, it is now legislation
, that prohibits anyone from knowingly submitting or causing to be submitted
a false or fraudulent claim. DOJ.
6. Qui Tam Action - ANSWER ✔ Allows persons and entities with evidence
of fraud against federal programs or contracts to sue the wrongdoer on
behalf of the United States Government - based upon private information.
7. 7 Elements of an Effective Compliance Program - ANSWER ✔ 1. Policies
and Procedures
2. Compliance Oversight
3. Effective Lines of Communication
4. Training / Education
5. Internal Monitoring and Auditing
6. Enforcing standards through consistent disciplinary guidelines
7. Responding timely to detracted offenses.
8. HIPAA Privacy Rule - ANSWER ✔ A covered entity may not use of
disclose protected health information except for when it is required or
permitted.
9. HIPAA Security Rule - ANSWER ✔ Essentially outlines how to protect
PHI in an electronic form (only applies to ePHI). 3 main safeguards:
administrative, technical, and physical.
10.Reportable Breach - ANSWER ✔ 1. breach of privacy rule
2. unsecured PHI
3. more than "low probability of compromise"
11.After hiring, how often should providers check to make sure employees are
not on the OIG List of Excluded Individuals?
a. Annually
b. Monthly
c. Quarterly
d. Once every 10 years - ANSWER ✔ b. Monthly
To avoid liability for employing excluded entities, providers should check the
OIG List of Excluded Individuals Entities (LEIE) on the OIG website, as well
as any state exclusion website.
Note: practice question from AAPC CPCO Ch4
,12.There are many different regulatory agencies that identify compliance risks.
- ANSWER ✔ 1. SEC,
2. JCAHO,
3. Dept of Labor,
4. Dept of Transportation,
5. Dept of Justice,
6. Drug Enforcement Agency,
7. DME,
8. OIG,
9. FTC,
10. HHS,
11. OSHA
12. Treasury,
13. FBI
13.CMS Questions
Part A covers what?
Part B covers what?
Part C covers what?
Part D covers what? - ANSWER ✔ Part A - inpatient hospital (i.e. home
health, SNF)
Part B - outpatient services (i.e. physician billing, PFS)
Part C - Medicare Advantage
Part D - prescription drugs/pharmacy
14.Medicaid - Deficit Reduction Act of 2005 - ANSWER ✔ Grants states to
modify their Medicaid Programs and allows them to expand eligibility and
thus access to services
15.Sarbanes-Oxley Act of 2002 or SOX Act - ANSWER ✔ Federal law that
established sweeping auditing and financial regulations for public
companies. Lawmakers created the legislation to help protect shareholders,
employees and the public from accounting errors and fraudulent financial
practices.
It was enacted in response to a series of high-profile financial scandals that
occurred in the early 2000s (i.e. Enron). Learn more:
https://www.congress.gov/bill/107th-congress/house-bill/3763
, 16.A privacy official is asked to approve a transfer form that would have the
patient's SS# on the top of the page to go with a patient from the privacy
officer's facility to another facility when a patient is transferred. The nursing
leadership at the facility is insisting that they "have to have" the patient's
SS# when making transfer arrangements from one facility to another. The
BEST course of action for the privacy officer to take is:
A. Ask the nursing leadership to update the policy on transfers to
include that social security numbers must be included on
transfer paperwork.
B. Have the appropriate forms updated/revised/edited so that
they can now accommodate the social security numbers.
C. Confirm with nursing any regulations or other requirements
that state social security numbers must be included on transfer
forms
D. Contact the legal department. - ANSWER ✔ C. Confirm
with nursing any regulations or other requirements that state
social security numbers must be included on transfer forms
17.Home health coverage criteria include the beneficiary must
A. have been hospitalized within the past 72 hours and under the
care of a physician.
B. be currently enrolled in a Medicare managed care plan and
have a condition needing skilled services.
C. require the services of a skilled nurse and not be able to leave
place of residence.
D. be homebound, require skilled services and be under the care
of a physician. - ANSWER ✔ D. be homebound, require
skilled services and be under the care of a physician
18.Your organization is interviewing for a new Compliance Officer. Which of
the following qualifications is the least important?
a. The candidate is trustworthy
b. The candidate has a working knowledge of your operations
c. The candidate's previous position was an Internal Auditor who
understands healthcare billing
d. The candidate has experience with conflict resolution - ANSWER ✔
b. The candidate has a working knowledge of your operation
2026/2027 ACCURATE QUESTIONS WITH
CORRECT DETAILED SOLUTIONS ||
100% GUARANTEED PASS
<NEWEST VERSION>
1. Stark or Physician Self-Referral Law - ANSWER ✔ The Omnibus Budget
Reconciliation Act bans physicians from referring patients to receive
"designated health services" to any entity with which the physician has a
financial relationship. Designated health services include lab testing,
imaging services, physical or occupational therapy, etc. (civil only,
medicare/medicaid only, strict liability)
2. Anti-Kickback Statute (AKS) - ANSWER ✔ Prohibits the solicitation,
receiving, offering, or paying any remuneration directly or indirectly in cash
or in kind in exchange. Essentially it prohibits the exchange of anything of
value in exchange for or in an effort to gain the referral of business
reimbursable by federal healthcare programs. (intent, any federal program,
civil or criminal)
3. Physician Payments Sunshine Act (PPSA) - ANSWER ✔ Requires that
detailed information about payments or other "transfers of value" worth over
$10 from manufacturers of drugs, medical devices and biologics to
physicians and teaching hospitals be made available to the public. (Open
payment data).
4. Deficit Reduction Act - ANSWER ✔ A Federal law that grants states the
ability to modify their Medicaid programs. This allows individual states to
reform their Medicaid programs to fit with the present health care
environment while maintaining federal guidelines.
5. False Claims Act - ANSWER ✔ Originally adopted byt U.S. Congress to
discourage suppliers from overcharging the government, it is now legislation
, that prohibits anyone from knowingly submitting or causing to be submitted
a false or fraudulent claim. DOJ.
6. Qui Tam Action - ANSWER ✔ Allows persons and entities with evidence
of fraud against federal programs or contracts to sue the wrongdoer on
behalf of the United States Government - based upon private information.
7. 7 Elements of an Effective Compliance Program - ANSWER ✔ 1. Policies
and Procedures
2. Compliance Oversight
3. Effective Lines of Communication
4. Training / Education
5. Internal Monitoring and Auditing
6. Enforcing standards through consistent disciplinary guidelines
7. Responding timely to detracted offenses.
8. HIPAA Privacy Rule - ANSWER ✔ A covered entity may not use of
disclose protected health information except for when it is required or
permitted.
9. HIPAA Security Rule - ANSWER ✔ Essentially outlines how to protect
PHI in an electronic form (only applies to ePHI). 3 main safeguards:
administrative, technical, and physical.
10.Reportable Breach - ANSWER ✔ 1. breach of privacy rule
2. unsecured PHI
3. more than "low probability of compromise"
11.After hiring, how often should providers check to make sure employees are
not on the OIG List of Excluded Individuals?
a. Annually
b. Monthly
c. Quarterly
d. Once every 10 years - ANSWER ✔ b. Monthly
To avoid liability for employing excluded entities, providers should check the
OIG List of Excluded Individuals Entities (LEIE) on the OIG website, as well
as any state exclusion website.
Note: practice question from AAPC CPCO Ch4
,12.There are many different regulatory agencies that identify compliance risks.
- ANSWER ✔ 1. SEC,
2. JCAHO,
3. Dept of Labor,
4. Dept of Transportation,
5. Dept of Justice,
6. Drug Enforcement Agency,
7. DME,
8. OIG,
9. FTC,
10. HHS,
11. OSHA
12. Treasury,
13. FBI
13.CMS Questions
Part A covers what?
Part B covers what?
Part C covers what?
Part D covers what? - ANSWER ✔ Part A - inpatient hospital (i.e. home
health, SNF)
Part B - outpatient services (i.e. physician billing, PFS)
Part C - Medicare Advantage
Part D - prescription drugs/pharmacy
14.Medicaid - Deficit Reduction Act of 2005 - ANSWER ✔ Grants states to
modify their Medicaid Programs and allows them to expand eligibility and
thus access to services
15.Sarbanes-Oxley Act of 2002 or SOX Act - ANSWER ✔ Federal law that
established sweeping auditing and financial regulations for public
companies. Lawmakers created the legislation to help protect shareholders,
employees and the public from accounting errors and fraudulent financial
practices.
It was enacted in response to a series of high-profile financial scandals that
occurred in the early 2000s (i.e. Enron). Learn more:
https://www.congress.gov/bill/107th-congress/house-bill/3763
, 16.A privacy official is asked to approve a transfer form that would have the
patient's SS# on the top of the page to go with a patient from the privacy
officer's facility to another facility when a patient is transferred. The nursing
leadership at the facility is insisting that they "have to have" the patient's
SS# when making transfer arrangements from one facility to another. The
BEST course of action for the privacy officer to take is:
A. Ask the nursing leadership to update the policy on transfers to
include that social security numbers must be included on
transfer paperwork.
B. Have the appropriate forms updated/revised/edited so that
they can now accommodate the social security numbers.
C. Confirm with nursing any regulations or other requirements
that state social security numbers must be included on transfer
forms
D. Contact the legal department. - ANSWER ✔ C. Confirm
with nursing any regulations or other requirements that state
social security numbers must be included on transfer forms
17.Home health coverage criteria include the beneficiary must
A. have been hospitalized within the past 72 hours and under the
care of a physician.
B. be currently enrolled in a Medicare managed care plan and
have a condition needing skilled services.
C. require the services of a skilled nurse and not be able to leave
place of residence.
D. be homebound, require skilled services and be under the care
of a physician. - ANSWER ✔ D. be homebound, require
skilled services and be under the care of a physician
18.Your organization is interviewing for a new Compliance Officer. Which of
the following qualifications is the least important?
a. The candidate is trustworthy
b. The candidate has a working knowledge of your operations
c. The candidate's previous position was an Internal Auditor who
understands healthcare billing
d. The candidate has experience with conflict resolution - ANSWER ✔
b. The candidate has a working knowledge of your operation
