CHC Auditing & Monitoring (3) UPDATED
ACTUAL Exam Questions and CORRECT
Answers
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
A billing manager is reviewing the monthly reimbursement report for the department. The
manager notices that there is an increase of 50% over the expected amount of incoming
payments from Federal health care programs for treatment of patients. The manager believes
action is needed. The manager's NEXT step is to:
1. Stop all outgoing claims to Federal health care programs
2. Extrapolate the last 6 months of reimbursement totals to identify the overpayment due to
health care programs
3. Contact legal for next steps or further direction to include advice on how to proceed with the
self disclosure protocol
4. Analyze the details related to the increase in payments to identify possible sources or causes
for increase in reimbursement - CORRECT ANSWER - 4. Analyze the details related to
the increase in payments to identify possible sources or causes for increase in reimbursement
If during the course of an internal investigation, the compliance officer believes the integrity of
the investigation might be compromised by the continued presence of work force members who
are the subject of the investigation. In the best interest of the attorney-client privilege, which
action would you to take?
a. Conduct employee background checks
b. Counsel obtains employee's depositions
c. Destroy documents and other evidence
d. Re-assign employees to other responsibilities until the investigation is completed
, e. All of the above - CORRECT ANSWER - d. Re-assign employees to other
responsibilities until the investigation is completed.
Explanation: he/she should recommend that such individuals be temporarily removed from their
current responsibilities until the investigation is completed.
Ref. Healthcare Compliance Professional's Manual
A common reporting system, administered in house or by outside consultants, giving anonymous
telephone access to employees seeking to report possible instances of wrongdoing - CORRECT
ANSWER - Hotline or Helpline
Reporting systems should be:
a. marketed to contractors
b. outsourced to a vendor
c. operated by management
d. publicized to all employees - CORRECT ANSWER - d. publicized to all employees
A primary source of information for the team conducting an audit would be:
a. OIG work Plan
b. Organization's existing documents
c. CPT and ICD10 books
d. HCCA
e. Investigation Procedures
f. Promise of non-retaliation
g. Chain of command - CORRECT ANSWER - b. Organization's existing documents
CMS ______________ Programs:
1. are administered by individual states
2. some older adults have this program as a secondary insurance
ACTUAL Exam Questions and CORRECT
Answers
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
A billing manager is reviewing the monthly reimbursement report for the department. The
manager notices that there is an increase of 50% over the expected amount of incoming
payments from Federal health care programs for treatment of patients. The manager believes
action is needed. The manager's NEXT step is to:
1. Stop all outgoing claims to Federal health care programs
2. Extrapolate the last 6 months of reimbursement totals to identify the overpayment due to
health care programs
3. Contact legal for next steps or further direction to include advice on how to proceed with the
self disclosure protocol
4. Analyze the details related to the increase in payments to identify possible sources or causes
for increase in reimbursement - CORRECT ANSWER - 4. Analyze the details related to
the increase in payments to identify possible sources or causes for increase in reimbursement
If during the course of an internal investigation, the compliance officer believes the integrity of
the investigation might be compromised by the continued presence of work force members who
are the subject of the investigation. In the best interest of the attorney-client privilege, which
action would you to take?
a. Conduct employee background checks
b. Counsel obtains employee's depositions
c. Destroy documents and other evidence
d. Re-assign employees to other responsibilities until the investigation is completed
, e. All of the above - CORRECT ANSWER - d. Re-assign employees to other
responsibilities until the investigation is completed.
Explanation: he/she should recommend that such individuals be temporarily removed from their
current responsibilities until the investigation is completed.
Ref. Healthcare Compliance Professional's Manual
A common reporting system, administered in house or by outside consultants, giving anonymous
telephone access to employees seeking to report possible instances of wrongdoing - CORRECT
ANSWER - Hotline or Helpline
Reporting systems should be:
a. marketed to contractors
b. outsourced to a vendor
c. operated by management
d. publicized to all employees - CORRECT ANSWER - d. publicized to all employees
A primary source of information for the team conducting an audit would be:
a. OIG work Plan
b. Organization's existing documents
c. CPT and ICD10 books
d. HCCA
e. Investigation Procedures
f. Promise of non-retaliation
g. Chain of command - CORRECT ANSWER - b. Organization's existing documents
CMS ______________ Programs:
1. are administered by individual states
2. some older adults have this program as a secondary insurance
