HCCA - CHC Study 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
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%20protect%20y
ou%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.
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 - CORRECT ANSWER - a. annual evaluations
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
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
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%20protect%20y
ou%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.
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 - CORRECT ANSWER - a. annual evaluations
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
