HCCA - CHC Study Questions (MASTER
FLASHCARDS) 2025 TEST LATEST QUIZ
WITH VERIFIED ANSWERS ALREADY
GRADED
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). -
CORRECT ANSWER-True
ref. ACA section 6102
According to HHS-OIG - what are three important reasons for proper documentation in
Compliance? (hint: protections) - CORRECT 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%20prot
ect%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 - CORRECT 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. - CORRECT 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 - CORRECT 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 - CORRECT ANSWER-d. will not
be successful without the proper oversight
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.
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 - CORRECT ANSWER-b. increasing management
involvement.
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.
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 1128d - CORRECT ANSWER-c. Balance Budget Act of
1997
Also known as a BBA "three strikes rule"
What section of the ACA prevents discrimination against individuals with limited English
proficiency (LEP), and also prohibits discrimination in healthcare programs and activities
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 - CORRECT ANSWER-b. ACA section 1557 is the correct 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.
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. - CORRECT 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 - CORRECT 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 - CORRECT ANSWER-Creation
Use
Maintenance
Retention
Disposition
, Standards qof qConduct q(written qP&Ps) q- qCORRECT qANSWER-Demonstrate qthe
qorganization's qethical qattitude qand qits q"enterprise-wide" qemphasis qon qcompliance qwith
qall qapplicable qlaws qand qregulations
Code qof qConduct: qContent qChecklist q- qCORRECT qANSWER-• qDemonstrate qsystem
qwide qemphasis qon qcompliance qwith qall qapplicable qlaws qand qregulations
• qWritten qplainly qand qconcisely qso qall qemployees qcan qunderstand qthe qstandards
• qIncludes qinternal qand qexternal qregulations
• qMentions qorganizational qpolicies qwithout qcompletely qrestating qthem
• qIs qconsistent qwith qcompany qpolicies qand qprocedures
• qIncludes qmanagement's qresponsibility qto qexplain qand qenforce qthe qcode
Ref: qSCCE qCompliance q& qEthics qManual, qChapter q2
https://compliancecosmos.org/essential-elements-effective-ethics-and-compliance-
program
Code qof qConduct qand qEmployees q- qCORRECT qANSWER-All qemployees qmust qreceive,
qread, qand qunderstand qthe qstandards. q
A qsupervisor qshould qexplain qthe qstandards qand qanswer qany qquestions.
Employee qshould qattest qin qwriting qthat qthey qhave qreceived, qread, qand qunderstood qthe
qstandards
Employee qcompliance qwith qstandards qmust qbe qenforced qthrough qappropriate qdiscipline
qwhen qnecessary q
Discipline qfor qnon-compliance qshould qbe qstated qin qthe qstandards
Code qof qConduct qPurpose q- qCORRECT qANSWER-• qTo qpresent qspecific qguidelines qfor
qemployees qto qfollow
• qTo qconfirm qthat qall qemployees qcomprehend qwhat qis qrequired qof qthem
• qTo qprovide qa qprocess qfor qproper qdecision qmaking
• qTo qconfirm qthat qemployees qput qstandards qinto qeveryday qpractice
• qTo qelevate qcorporate qperformance qin qbasic qbusiness qrelationship
• qTo qconfirm qthat qthe qorganization qupholds qand qsupports qproper qcompliance qconduct
Every qorganization qneeds qpolicies qand qprocedures qfor: q- qCORRECT qANSWER-•
qInternal qassessments
• qRecord qretention q(where, qhow qlong)
• qSelf-disclosure
• qMedicare qsanction qchecks q(LEIE)
• qBilling qpolicies
• qCredit qbalance
• qNo qcharge qvisits
• qIncomplete/unsuccessful qprocedure
• qDocumentation qrequirements
When qshould qCode qof qConduct qbe qdistributed qto qnew qemployees? q- qCORRECT
qANSWER-Must qbe qdistributed qwithin q90 qdays qof qhire
FLASHCARDS) 2025 TEST LATEST QUIZ
WITH VERIFIED ANSWERS ALREADY
GRADED
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). -
CORRECT ANSWER-True
ref. ACA section 6102
According to HHS-OIG - what are three important reasons for proper documentation in
Compliance? (hint: protections) - CORRECT 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%20prot
ect%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 - CORRECT 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. - CORRECT 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 - CORRECT 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 - CORRECT ANSWER-d. will not
be successful without the proper oversight
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.
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 - CORRECT ANSWER-b. increasing management
involvement.
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.
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 1128d - CORRECT ANSWER-c. Balance Budget Act of
1997
Also known as a BBA "three strikes rule"
What section of the ACA prevents discrimination against individuals with limited English
proficiency (LEP), and also prohibits discrimination in healthcare programs and activities
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 - CORRECT ANSWER-b. ACA section 1557 is the correct 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.
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. - CORRECT 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 - CORRECT 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 - CORRECT ANSWER-Creation
Use
Maintenance
Retention
Disposition
, Standards qof qConduct q(written qP&Ps) q- qCORRECT qANSWER-Demonstrate qthe
qorganization's qethical qattitude qand qits q"enterprise-wide" qemphasis qon qcompliance qwith
qall qapplicable qlaws qand qregulations
Code qof qConduct: qContent qChecklist q- qCORRECT qANSWER-• qDemonstrate qsystem
qwide qemphasis qon qcompliance qwith qall qapplicable qlaws qand qregulations
• qWritten qplainly qand qconcisely qso qall qemployees qcan qunderstand qthe qstandards
• qIncludes qinternal qand qexternal qregulations
• qMentions qorganizational qpolicies qwithout qcompletely qrestating qthem
• qIs qconsistent qwith qcompany qpolicies qand qprocedures
• qIncludes qmanagement's qresponsibility qto qexplain qand qenforce qthe qcode
Ref: qSCCE qCompliance q& qEthics qManual, qChapter q2
https://compliancecosmos.org/essential-elements-effective-ethics-and-compliance-
program
Code qof qConduct qand qEmployees q- qCORRECT qANSWER-All qemployees qmust qreceive,
qread, qand qunderstand qthe qstandards. q
A qsupervisor qshould qexplain qthe qstandards qand qanswer qany qquestions.
Employee qshould qattest qin qwriting qthat qthey qhave qreceived, qread, qand qunderstood qthe
qstandards
Employee qcompliance qwith qstandards qmust qbe qenforced qthrough qappropriate qdiscipline
qwhen qnecessary q
Discipline qfor qnon-compliance qshould qbe qstated qin qthe qstandards
Code qof qConduct qPurpose q- qCORRECT qANSWER-• qTo qpresent qspecific qguidelines qfor
qemployees qto qfollow
• qTo qconfirm qthat qall qemployees qcomprehend qwhat qis qrequired qof qthem
• qTo qprovide qa qprocess qfor qproper qdecision qmaking
• qTo qconfirm qthat qemployees qput qstandards qinto qeveryday qpractice
• qTo qelevate qcorporate qperformance qin qbasic qbusiness qrelationship
• qTo qconfirm qthat qthe qorganization qupholds qand qsupports qproper qcompliance qconduct
Every qorganization qneeds qpolicies qand qprocedures qfor: q- qCORRECT qANSWER-•
qInternal qassessments
• qRecord qretention q(where, qhow qlong)
• qSelf-disclosure
• qMedicare qsanction qchecks q(LEIE)
• qBilling qpolicies
• qCredit qbalance
• qNo qcharge qvisits
• qIncomplete/unsuccessful qprocedure
• qDocumentation qrequirements
When qshould qCode qof qConduct qbe qdistributed qto qnew qemployees? q- qCORRECT
qANSWER-Must qbe qdistributed qwithin q90 qdays qof qhire
