CHC Study Guide UPDATED
ACTUAL Exam Questions and
CORRECT Answers
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Terms in this set (348)
Federal 1. upper-level employee
Sentencing participates, condones, or ignores
Guidelines - offense
Culpability 2. repeat offense
Score 3. hinder investigation
Aggravating 4. awareness and tolerance of
Factors violation is pervasive
,Federal 1. effective compliance program
Sentencing 2. reported promptly
Guidelines - 3. cooperation with investigation
Culpability 4. accept responsibility
Score Mitigating
Factors
1. written standards of conduct
2. Chief Compliance Officer
Federal 3. effective education and training
Sentencing 4. audits and evaluations to monitor
Guidelines - compliance
Seven Elements 5. reporting processes and
of an Effective procedures for complaints
Compliance 6. appropriate disciplinary
Program mechanisms
7. investigation and remediation of
systematic problems
The only thing ...having a policy and not following
worse than not it.
having a policy
is...
Medicare International Classification of
reimbursement - Diseases (ICD)
hospital inpatient
codes
,Medicare Current Procedural Technology
reimbursement - (CPT)
physician codes
1. What is the origin of the issue?
Questions to 2. When did the issue originate?
guide the scope 3. How far back should the
of an internal investigation go?
investigation. 4. Can extrapolation of a statistical
sample be used?
It is in the best ...take an active rather than a passive
interest of the role in compliance.
organization to
have the board
_______.
1. embed quality into existing
processes
2. centralize common processes and
controls
Six tips for
3. improve human resources
saving on future
infrastructures
costs of
4. improve information systems
compliance.
processes
5. emphasize training
6. monitor marketing and
compensation
, 1. outline the current operational
standards
Baseline Audit
2. identify real and potential
Process
weaknesses
3. offer recommendations
1. staff knowledge
2. all 7 elements included
3. comparing issues year to year
4. tracking and trending complaints
5. tracking corrective actions
Compliance
6. reviewing current audits
Program -
7. educational session pre and post
Measures of
tests
Effectiveness
8. tracking bill denials
9. organizational survey results
10. audit results
11. compliance topics on
department/organization agendas
a two digit alpha/numeric code
used in conjunction with CPT or
HCPCS codes that may increase or
Modifier
decrease reimbursement
gives new meaning to the code
ACTUAL Exam Questions and
CORRECT Answers
Save
Terms in this set (348)
Federal 1. upper-level employee
Sentencing participates, condones, or ignores
Guidelines - offense
Culpability 2. repeat offense
Score 3. hinder investigation
Aggravating 4. awareness and tolerance of
Factors violation is pervasive
,Federal 1. effective compliance program
Sentencing 2. reported promptly
Guidelines - 3. cooperation with investigation
Culpability 4. accept responsibility
Score Mitigating
Factors
1. written standards of conduct
2. Chief Compliance Officer
Federal 3. effective education and training
Sentencing 4. audits and evaluations to monitor
Guidelines - compliance
Seven Elements 5. reporting processes and
of an Effective procedures for complaints
Compliance 6. appropriate disciplinary
Program mechanisms
7. investigation and remediation of
systematic problems
The only thing ...having a policy and not following
worse than not it.
having a policy
is...
Medicare International Classification of
reimbursement - Diseases (ICD)
hospital inpatient
codes
,Medicare Current Procedural Technology
reimbursement - (CPT)
physician codes
1. What is the origin of the issue?
Questions to 2. When did the issue originate?
guide the scope 3. How far back should the
of an internal investigation go?
investigation. 4. Can extrapolation of a statistical
sample be used?
It is in the best ...take an active rather than a passive
interest of the role in compliance.
organization to
have the board
_______.
1. embed quality into existing
processes
2. centralize common processes and
controls
Six tips for
3. improve human resources
saving on future
infrastructures
costs of
4. improve information systems
compliance.
processes
5. emphasize training
6. monitor marketing and
compensation
, 1. outline the current operational
standards
Baseline Audit
2. identify real and potential
Process
weaknesses
3. offer recommendations
1. staff knowledge
2. all 7 elements included
3. comparing issues year to year
4. tracking and trending complaints
5. tracking corrective actions
Compliance
6. reviewing current audits
Program -
7. educational session pre and post
Measures of
tests
Effectiveness
8. tracking bill denials
9. organizational survey results
10. audit results
11. compliance topics on
department/organization agendas
a two digit alpha/numeric code
used in conjunction with CPT or
HCPCS codes that may increase or
Modifier
decrease reimbursement
gives new meaning to the code
