HCCA CHC/CHPC COMPLIANCE EXAM | Questions with
100% Verified Answers | Latest Update 2026/2027
Question: True or False: The ACA requires that all providers adopt a compliance plan
Answer: True
Question: as a condition of enrollment with Medicare, Medicaid, and Children's Health
Insurance Program (CHIP).
Answer: ref. ACA section 6102
Question: According to HHS-OIG - what are three important reasons for proper documentation
in Compliance? (hint: protections)
Answer: 1.Protect our programs
2.Protect your patients
3.Protect the Provider
https://oig.hhs.gov/newsroom/podcasts/2011/heat/heat09-
trans.asp#:~:text=Proper%20documentation%2C%20both%20in%20patients,to%20protect
%20you%20the%20provider.
Question: At which level of the Medicare Part A or Part B appeals process is the appeal
decision by the Office of Medicare
Answer: c. . third level of appeal
Question: Hearings and Appeals (OMHA)? a. first level of appeal b. second level of appeal c.
third level of appeal d. fourth level of appeal
Answer: Frist level - redetermination by Medicare contractor
Second level - reconsideration by Independent contractor
Third appeal - Administrative Law Judge (ALJ) hearing
Fourth appeal - review by Medicare Appeals Council
Fifth appeal - review in Federal District Court
https://www.hhs.gov/about/agencies/omha/the-appeals-process/index.html
Question: What should CCO be able to do? (What skills should this person have?) Choose all
that apply. a. Leadership skills. b. Oversee the coding department. c. Skills to
design and implement a compliance program. d. Be able to anticipate new risk
areas. e. Practical experience with documenting medical necessity.
Answer: a. Leadership skills,
c. Skills to design and implement a compliance program, and
d. Be able to anticipate new risk areas.
Question: Which of the following is an absolute necessity in order to have a successful
Compliance Program? a. continuous training and improvements b. effective
reporting path c. non-retaliation for whistleblowers d. reliable and equal discipline
Answer: c. non-retaliation for whistleblowers
,Question: A Compliance Program with well written policies and procedures:
Answer: d. will not be successful without the proper oversight
Question: a. can be successful if consistently reviewed and maintained b. cannot be effective
due to the sheer volume presented c. will be effective if read by management d.
will not be successful without the proper oversight
Answer: Regardless of having the best written policies in place that are reviewed/maintained
consistently, and read and disseminated accordingly, will fail if there is no proper
oversight to ensure they are actually being followed and understood.
Question: A Compliance Officer can achieve a higher level of compliance and ethics
engagement by:
Answer: b. increasing management involvement.
Question: a. ensuring leadership reads the policies b. increasing management involvement c.
responding to compliance hotline calls d. monitoring the code of conduct
Answer: Compliance is everyone's responsibility, but management involvement is crucial.
They
have a direct contact with employees, they know and understand their staff's needs
and
concerns, and have the most influence over employee's actions and attitudes.
Employees
most likely use their direct manager(s) to raise concerns and the reason they are so
critical for an organization to foster a culture of compliance.
Question: Which of the following requires providers to be permanently excluded from all
federal health care programs if found guilty
Answer: c. Balance Budget Act of 1997
Question: of a healthcare related fraud a third time: a. Deficit Reduction Act of 2005 b. False
Claims Act c. Balance Budget Act of 1997 d. Social Security Act section 1128d
Answer: Also known as a BBA "three strikes rule"
Question: What section of the ACA prevents discrimination against individuals with limited
English proficiency (LEP), and also prohibits discrimination in healthcare programs
and activities
Answer: b. ACA section 1557 is the correct answer.
,Question: that receive federal funding, based on race, color, national origin, sex, age, or
disability. a. ACA section 6102 b. ACA section 1557 c. ACA section 6002
Answer: a. ACA section 6102 requires owners, operators, and administrators of LTC facilities
to
adopt effective compliance.
c. ACA section 6002 requires the establishment of a transparency program, now
known
as CMS Open Payments.
Question: Which statement is TRUE regarding compliance programs? a. Compliance programs
are considered more dangerous if they are developed but not implemented. b.
Compliance programs can detect but not prevent criminal conduct c. Compliance
programs are only required by law for healthcare entities that have more than
$500,000 in annual revenue. d. Compliance programs are not mandated by law.
Answer: a. Compliance programs are considered more dangerous if they are developed but
not
implemented.
Question: An individual's understanding of the compliance aspects of their job can BEST be
enhanced by including compliance in: a. annual evaluations b. exit interviews c. HR
benefit materials d. audit committee meetings
Answer: a. annual evaluations
Question: Formal statement outlining a plan for a specified subject area. It usually cites state
and/or federal required actions or
Answer: c. Policy document
Question: standards. a. CAP b. Procedure document c. Policy document d. Legal standards
Answer: CAP - outlines corrective action plan
Procedure - describes process/steps under a certain criteria
Legal standards - mandatory action or rule
Question: Life cycle of records management
Answer: Creation
Use
Maintenance
Retention
Disposition
Question: Standards of Conduct (written P&Ps)
Answer: Demonstrate the organization's ethical attitude and its "enterprise-wide" emphasis on
compliance with all applicable laws and regulations
, Question: Code of Conduct: Content Checklist
Answer: • Demonstrate system wide emphasis on compliance with all applicable laws and
regulations
• Written plainly and concisely so all employees can understand the standards
• Includes internal and external regulations
• Mentions organizational policies without completely restating them
• Is consistent with company policies and procedures
• Includes management's responsibility to explain and enforce the code
Ref: SCCE Compliance & Ethics Manual, Chapter 2
https://compliancecosmos.org/essential-elements-effective-ethics-and-compliance-
program
Question: Code of Conduct and Employees
Answer: All employees must receive, read, and understand the standards.
A supervisor should explain the standards and answer any questions.
Employee should attest in writing that they have received, read, and understood the
standards
Employee compliance with standards must be enforced through appropriate
discipline
when necessary
Discipline for non-compliance should be stated in the standards
Question: Code of Conduct Purpose
Answer: • To present specific guidelines for employees to follow
• To confirm that all employees comprehend what is required of them
• To provide a process for proper decision making
• To confirm that employees put standards into everyday practice
• To elevate corporate performance in basic business relationship
• To confirm that the organization upholds and supports proper compliance conduct
Question: Every organization needs policies and procedures for:
Answer: • Internal assessments
• Record retention (where, how long)
• Self-disclosure
• Medicare sanction checks (LEIE)
• Billing policies
• Credit balance
• No charge visits
• Incomplete/unsuccessful procedure
• Documentation requirements
Question: When should Code of Conduct be distributed to new employees?
Answer: Must be distributed within 90 days of hire
100% Verified Answers | Latest Update 2026/2027
Question: True or False: The ACA requires that all providers adopt a compliance plan
Answer: True
Question: as a condition of enrollment with Medicare, Medicaid, and Children's Health
Insurance Program (CHIP).
Answer: ref. ACA section 6102
Question: According to HHS-OIG - what are three important reasons for proper documentation
in Compliance? (hint: protections)
Answer: 1.Protect our programs
2.Protect your patients
3.Protect the Provider
https://oig.hhs.gov/newsroom/podcasts/2011/heat/heat09-
trans.asp#:~:text=Proper%20documentation%2C%20both%20in%20patients,to%20protect
%20you%20the%20provider.
Question: At which level of the Medicare Part A or Part B appeals process is the appeal
decision by the Office of Medicare
Answer: c. . third level of appeal
Question: Hearings and Appeals (OMHA)? a. first level of appeal b. second level of appeal c.
third level of appeal d. fourth level of appeal
Answer: Frist level - redetermination by Medicare contractor
Second level - reconsideration by Independent contractor
Third appeal - Administrative Law Judge (ALJ) hearing
Fourth appeal - review by Medicare Appeals Council
Fifth appeal - review in Federal District Court
https://www.hhs.gov/about/agencies/omha/the-appeals-process/index.html
Question: What should CCO be able to do? (What skills should this person have?) Choose all
that apply. a. Leadership skills. b. Oversee the coding department. c. Skills to
design and implement a compliance program. d. Be able to anticipate new risk
areas. e. Practical experience with documenting medical necessity.
Answer: a. Leadership skills,
c. Skills to design and implement a compliance program, and
d. Be able to anticipate new risk areas.
Question: Which of the following is an absolute necessity in order to have a successful
Compliance Program? a. continuous training and improvements b. effective
reporting path c. non-retaliation for whistleblowers d. reliable and equal discipline
Answer: c. non-retaliation for whistleblowers
,Question: A Compliance Program with well written policies and procedures:
Answer: d. will not be successful without the proper oversight
Question: a. can be successful if consistently reviewed and maintained b. cannot be effective
due to the sheer volume presented c. will be effective if read by management d.
will not be successful without the proper oversight
Answer: Regardless of having the best written policies in place that are reviewed/maintained
consistently, and read and disseminated accordingly, will fail if there is no proper
oversight to ensure they are actually being followed and understood.
Question: A Compliance Officer can achieve a higher level of compliance and ethics
engagement by:
Answer: b. increasing management involvement.
Question: a. ensuring leadership reads the policies b. increasing management involvement c.
responding to compliance hotline calls d. monitoring the code of conduct
Answer: Compliance is everyone's responsibility, but management involvement is crucial.
They
have a direct contact with employees, they know and understand their staff's needs
and
concerns, and have the most influence over employee's actions and attitudes.
Employees
most likely use their direct manager(s) to raise concerns and the reason they are so
critical for an organization to foster a culture of compliance.
Question: Which of the following requires providers to be permanently excluded from all
federal health care programs if found guilty
Answer: c. Balance Budget Act of 1997
Question: of a healthcare related fraud a third time: a. Deficit Reduction Act of 2005 b. False
Claims Act c. Balance Budget Act of 1997 d. Social Security Act section 1128d
Answer: Also known as a BBA "three strikes rule"
Question: What section of the ACA prevents discrimination against individuals with limited
English proficiency (LEP), and also prohibits discrimination in healthcare programs
and activities
Answer: b. ACA section 1557 is the correct answer.
,Question: that receive federal funding, based on race, color, national origin, sex, age, or
disability. a. ACA section 6102 b. ACA section 1557 c. ACA section 6002
Answer: a. ACA section 6102 requires owners, operators, and administrators of LTC facilities
to
adopt effective compliance.
c. ACA section 6002 requires the establishment of a transparency program, now
known
as CMS Open Payments.
Question: Which statement is TRUE regarding compliance programs? a. Compliance programs
are considered more dangerous if they are developed but not implemented. b.
Compliance programs can detect but not prevent criminal conduct c. Compliance
programs are only required by law for healthcare entities that have more than
$500,000 in annual revenue. d. Compliance programs are not mandated by law.
Answer: a. Compliance programs are considered more dangerous if they are developed but
not
implemented.
Question: An individual's understanding of the compliance aspects of their job can BEST be
enhanced by including compliance in: a. annual evaluations b. exit interviews c. HR
benefit materials d. audit committee meetings
Answer: a. annual evaluations
Question: Formal statement outlining a plan for a specified subject area. It usually cites state
and/or federal required actions or
Answer: c. Policy document
Question: standards. a. CAP b. Procedure document c. Policy document d. Legal standards
Answer: CAP - outlines corrective action plan
Procedure - describes process/steps under a certain criteria
Legal standards - mandatory action or rule
Question: Life cycle of records management
Answer: Creation
Use
Maintenance
Retention
Disposition
Question: Standards of Conduct (written P&Ps)
Answer: Demonstrate the organization's ethical attitude and its "enterprise-wide" emphasis on
compliance with all applicable laws and regulations
, Question: Code of Conduct: Content Checklist
Answer: • Demonstrate system wide emphasis on compliance with all applicable laws and
regulations
• Written plainly and concisely so all employees can understand the standards
• Includes internal and external regulations
• Mentions organizational policies without completely restating them
• Is consistent with company policies and procedures
• Includes management's responsibility to explain and enforce the code
Ref: SCCE Compliance & Ethics Manual, Chapter 2
https://compliancecosmos.org/essential-elements-effective-ethics-and-compliance-
program
Question: Code of Conduct and Employees
Answer: All employees must receive, read, and understand the standards.
A supervisor should explain the standards and answer any questions.
Employee should attest in writing that they have received, read, and understood the
standards
Employee compliance with standards must be enforced through appropriate
discipline
when necessary
Discipline for non-compliance should be stated in the standards
Question: Code of Conduct Purpose
Answer: • To present specific guidelines for employees to follow
• To confirm that all employees comprehend what is required of them
• To provide a process for proper decision making
• To confirm that employees put standards into everyday practice
• To elevate corporate performance in basic business relationship
• To confirm that the organization upholds and supports proper compliance conduct
Question: Every organization needs policies and procedures for:
Answer: • Internal assessments
• Record retention (where, how long)
• Self-disclosure
• Medicare sanction checks (LEIE)
• Billing policies
• Credit balance
• No charge visits
• Incomplete/unsuccessful procedure
• Documentation requirements
Question: When should Code of Conduct be distributed to new employees?
Answer: Must be distributed within 90 days of hire
