CERTIFIED COMPLIANCE & ETHICS PROFESSIONAL
(CCEP)& HEALTH CARE COMPLIANCE ASSOCIATION -
CERTIFIED IN HEALTHCARE COMPLIANCE (CHC)
True or False:
The ACA requires that all providers adopt a compliance plan as
a condition of enrollment with Medicare, Medicaid, and
Children's Health Insurance Program (CHIP). - ANSWER - >True
ref. ACA section 6102
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.
At which level of the Medicare Part A or Part B appeals process
is the appeal decision by the Office of Medicare 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 - >c. . third level of appeal
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
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.
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
,A Compliance Program with well written policies and
procedures:
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
- >d. will not be successful without the proper oversight
A Compliance Officer can achieve a higher level of compliance
and ethics engagement by:
a. ensuring leadership reads the policies
b. increasing management involvement
c. responding to compliance hotline calls
d. monitoring the code of conduct - ANSWER - >b. increasing
management involvement
Which of the following requires providers to be permanently
excluded from all federal health care programs if found guilty 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 1128 - ANSWER - >c. Balance
Budget Act of 1997
Also known as a BBA "three strikes rule"
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.
Formal statement outlining a plan for a specified subject area. It
usually cites state and/or federal required actions or standards.
a. CAP
b. Procedure document
c. Policy document
d. Legal standards - ANSWER - >c. Policy document
CAP - outlines corrective action plan
Procedure - describes process/steps under a certain criteria
Legal standards - mandatory action or rule
Life cycle of records management - ANSWER - >Creation
Use
Maintenance
Retention
Disposition
Standards of Conduct (written P&Ps) - ANSWER - >Demonstrate
the organization's ethical attitude and its "enterprise-wide"
(CCEP)& HEALTH CARE COMPLIANCE ASSOCIATION -
CERTIFIED IN HEALTHCARE COMPLIANCE (CHC)
True or False:
The ACA requires that all providers adopt a compliance plan as
a condition of enrollment with Medicare, Medicaid, and
Children's Health Insurance Program (CHIP). - ANSWER - >True
ref. ACA section 6102
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.
At which level of the Medicare Part A or Part B appeals process
is the appeal decision by the Office of Medicare 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 - >c. . third level of appeal
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
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.
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
,A Compliance Program with well written policies and
procedures:
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
- >d. will not be successful without the proper oversight
A Compliance Officer can achieve a higher level of compliance
and ethics engagement by:
a. ensuring leadership reads the policies
b. increasing management involvement
c. responding to compliance hotline calls
d. monitoring the code of conduct - ANSWER - >b. increasing
management involvement
Which of the following requires providers to be permanently
excluded from all federal health care programs if found guilty 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 1128 - ANSWER - >c. Balance
Budget Act of 1997
Also known as a BBA "three strikes rule"
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.
Formal statement outlining a plan for a specified subject area. It
usually cites state and/or federal required actions or standards.
a. CAP
b. Procedure document
c. Policy document
d. Legal standards - ANSWER - >c. Policy document
CAP - outlines corrective action plan
Procedure - describes process/steps under a certain criteria
Legal standards - mandatory action or rule
Life cycle of records management - ANSWER - >Creation
Use
Maintenance
Retention
Disposition
Standards of Conduct (written P&Ps) - ANSWER - >Demonstrate
the organization's ethical attitude and its "enterprise-wide"
