CHC Exam UPDATED ACTUAL Exam
Questions and CORRECT Answers
7 elements - CORRECT ANSWER - Policies & Procedures
Oversight Responsibilities/Assignments
Oversight Responsibilities/Due Care
Education and Training
Monitoring and Auditing
Enforcement and Discipline
Response and Prevention
ECHO - CORRECT ANSWER - Economic, Clinical and Humanistic Outcomes
Economic Outcomes - CORRECT ANSWER - Comparison between the cost of what was
received and the benefit derived from alternatives
Clinical Outcomes - CORRECT ANSWER - Changes to moribity/mortality rates as a
result of healthcare intervention
Humanistic Outcomes - CORRECT ANSWER - Psychological consequences of healthcare
which include patient measures of functional status, quality of life and satisfaction with care
A formal system that assures that products or services meet the characteristics associated with
excellence - CORRECT ANSWER - Quality Assurance
Process of identifying/evaluating quality of patient care services to ensure that a predetermined
standard is being met - CORRECT ANSWER - QA
Based on the assumption that quality can never be completely assured - a sustained program for
identifying opportunities is necessary - CORRECT ANSWER - Quality Improvement
,Continuously improve the ability of all processes to meet the needs of customers - CORRECT
ANSWER - QI
Proactive, positive - CORRECT ANSWER - QI
Reactive - focus on negative (look/find errors/correct) - CORRECT ANSWER - QA
HMO, PPO, EPO - CORRECT ANSWER - Managed Care Organizations
How do you determine the effectiveness of compliance education and training? - CORRECT
ANSWER - Program evaluation summaries; post-tests; and internal and external
monitoring and evaluation
A relative value assigned to a diagnosis related group of patients in a medical care environment -
CORRECT ANSWER - Case Mix INdex
What is the case mix index used for? - CORRECT ANSWER - To determine the
allocation of resources to care for and/or treat the patients in a group.
Groups having the same condition based on main and secondary diagnosis, procedures and age,
complexity and needs - CORRECT ANSWER - Diagnosis Related Groups (DRG) or
Resource Use Groups (RUG)
What has a relative average value assigned to it that indicates the amount of resources required to
treat patients in a group, as compared to all of the other diagnosis-related groups within the
system? - CORRECT ANSWER - DRG
What does the CMI of a hospital reflect? - CORRECT ANSWER - The diversity, clinical
complexity and needs for resources in the population of all patients in the hospital
,EMTALA - CORRECT ANSWER - Emergency Medical Treatment and Labor Act
What does EMTALA Require? - CORRECT ANSWER - EDs to medically screen every
patient who seeks emergency care and to stabilize or transfer those with medical emergencies,
regardless of health insurance status or ability to pay
What is EMTALA a part of? - CORRECT ANSWER - COBRA
What is EMTALA designed to prevent? - CORRECT ANSWER - To prevent hospitals
from refusing to see or transferring financially undesirable patients to public hospitals without, at
a minimum, providing a medical screening examination and treatment to ensure they are stable
for transfer.
What are the CMPs for hospitals and physicians who violate EMTALA? - CORRECT
ANSWER - $50,000 per violation
What is another penalty of violating EMTALA besides CMPs? - CORRECT ANSWER -
Threat of Medicare decertification
Any individual who comes and requests exam or treatment of a medical condition must receive a
medical screening exam to determine whether an emergency medical condition exists.
If an emergency medical condition exits, treatment must be provided until it is resolved or
stabilized
Hospitals with specialized capabilities are obligated to accept transfers from hospitals who lack
the capability to treat unstable emergency medical conditions. - CORRECT ANSWER -
EMTALA Objectives
When is a patient considered stable for transfer under EMTALA? - CORRECT
ANSWER - IF the treating physician determines that no material deterioration is
reasonably likely to occur during or as a result of the transfer between facilities.
, If a patient is unstable, can the hospital transfer the patient under EMTALA? - CORRECT
ANSWER - Only if one of the two below:
A physician certifies the medical benefits expected from the transfer outweigh the risks
A patient makes a transfer request in writing after being informed of the hospital's obligations
under EMTALA and the risks of transfer.
Who has enforcement powers under EMTALA for violations? - CORRECT ANSWER -
CMS - Hospitals
OIG - Hospitals and Physicians
What penalties may be assessed under EMTALA? - CORRECT ANSWER - Termination
of hospital/physician's Medicare provider agreement
Hospital fines up to $50,000 per violation ($25,000 for a hospital with fewer than 100 beds)
Physician fines up to $50,000 per violation, including on-call physicians
The hospital may be sued for personal injury in civil court under a private cause of action
AKS - CORRECT ANSWER - Anti-Kickback Statute
What is the AKS - CORRECT ANSWER - It prohibits offering, paying, soliciting or
receiving anything of value to induce or reward referrals or generate Federal health care program
business
Under AKS, what constitutes a referral? - CORRECT ANSWER - Referral from/to anyone
Questions and CORRECT Answers
7 elements - CORRECT ANSWER - Policies & Procedures
Oversight Responsibilities/Assignments
Oversight Responsibilities/Due Care
Education and Training
Monitoring and Auditing
Enforcement and Discipline
Response and Prevention
ECHO - CORRECT ANSWER - Economic, Clinical and Humanistic Outcomes
Economic Outcomes - CORRECT ANSWER - Comparison between the cost of what was
received and the benefit derived from alternatives
Clinical Outcomes - CORRECT ANSWER - Changes to moribity/mortality rates as a
result of healthcare intervention
Humanistic Outcomes - CORRECT ANSWER - Psychological consequences of healthcare
which include patient measures of functional status, quality of life and satisfaction with care
A formal system that assures that products or services meet the characteristics associated with
excellence - CORRECT ANSWER - Quality Assurance
Process of identifying/evaluating quality of patient care services to ensure that a predetermined
standard is being met - CORRECT ANSWER - QA
Based on the assumption that quality can never be completely assured - a sustained program for
identifying opportunities is necessary - CORRECT ANSWER - Quality Improvement
,Continuously improve the ability of all processes to meet the needs of customers - CORRECT
ANSWER - QI
Proactive, positive - CORRECT ANSWER - QI
Reactive - focus on negative (look/find errors/correct) - CORRECT ANSWER - QA
HMO, PPO, EPO - CORRECT ANSWER - Managed Care Organizations
How do you determine the effectiveness of compliance education and training? - CORRECT
ANSWER - Program evaluation summaries; post-tests; and internal and external
monitoring and evaluation
A relative value assigned to a diagnosis related group of patients in a medical care environment -
CORRECT ANSWER - Case Mix INdex
What is the case mix index used for? - CORRECT ANSWER - To determine the
allocation of resources to care for and/or treat the patients in a group.
Groups having the same condition based on main and secondary diagnosis, procedures and age,
complexity and needs - CORRECT ANSWER - Diagnosis Related Groups (DRG) or
Resource Use Groups (RUG)
What has a relative average value assigned to it that indicates the amount of resources required to
treat patients in a group, as compared to all of the other diagnosis-related groups within the
system? - CORRECT ANSWER - DRG
What does the CMI of a hospital reflect? - CORRECT ANSWER - The diversity, clinical
complexity and needs for resources in the population of all patients in the hospital
,EMTALA - CORRECT ANSWER - Emergency Medical Treatment and Labor Act
What does EMTALA Require? - CORRECT ANSWER - EDs to medically screen every
patient who seeks emergency care and to stabilize or transfer those with medical emergencies,
regardless of health insurance status or ability to pay
What is EMTALA a part of? - CORRECT ANSWER - COBRA
What is EMTALA designed to prevent? - CORRECT ANSWER - To prevent hospitals
from refusing to see or transferring financially undesirable patients to public hospitals without, at
a minimum, providing a medical screening examination and treatment to ensure they are stable
for transfer.
What are the CMPs for hospitals and physicians who violate EMTALA? - CORRECT
ANSWER - $50,000 per violation
What is another penalty of violating EMTALA besides CMPs? - CORRECT ANSWER -
Threat of Medicare decertification
Any individual who comes and requests exam or treatment of a medical condition must receive a
medical screening exam to determine whether an emergency medical condition exists.
If an emergency medical condition exits, treatment must be provided until it is resolved or
stabilized
Hospitals with specialized capabilities are obligated to accept transfers from hospitals who lack
the capability to treat unstable emergency medical conditions. - CORRECT ANSWER -
EMTALA Objectives
When is a patient considered stable for transfer under EMTALA? - CORRECT
ANSWER - IF the treating physician determines that no material deterioration is
reasonably likely to occur during or as a result of the transfer between facilities.
, If a patient is unstable, can the hospital transfer the patient under EMTALA? - CORRECT
ANSWER - Only if one of the two below:
A physician certifies the medical benefits expected from the transfer outweigh the risks
A patient makes a transfer request in writing after being informed of the hospital's obligations
under EMTALA and the risks of transfer.
Who has enforcement powers under EMTALA for violations? - CORRECT ANSWER -
CMS - Hospitals
OIG - Hospitals and Physicians
What penalties may be assessed under EMTALA? - CORRECT ANSWER - Termination
of hospital/physician's Medicare provider agreement
Hospital fines up to $50,000 per violation ($25,000 for a hospital with fewer than 100 beds)
Physician fines up to $50,000 per violation, including on-call physicians
The hospital may be sued for personal injury in civil court under a private cause of action
AKS - CORRECT ANSWER - Anti-Kickback Statute
What is the AKS - CORRECT ANSWER - It prohibits offering, paying, soliciting or
receiving anything of value to induce or reward referrals or generate Federal health care program
business
Under AKS, what constitutes a referral? - CORRECT ANSWER - Referral from/to anyone
