HCA Certification Training questions and
answers 2025\2026 A+ Grade
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
According to HHS-OIG - what are three important reasons for proper documentation in Compliance?
1.Protect our ___________________
2.Protect your ___________________
3.Protect the ___________________
- correct answer 1.Protect our programs
2.Protect your patients
3.Protect the Provider
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
,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.
What is the appeals process is the appeal decision by the Office of Medicare Hearings and Appeals
(OMHA)?
Frist level - _________________________
Second level - _________________________
Third appeal - _________________________
Fourth appeal - _________________________
Fifth appeal - _________________________
- correct answer 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
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
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
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 1128
- correct answer c. Balance Budget Act of 1997
Also known as a BBA "three strikes rule"
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
Life cycle of records management
C
U
M
R
D
- correct answer Creation
Use
Maintenance
Retention
Disposition
answers 2025\2026 A+ Grade
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
According to HHS-OIG - what are three important reasons for proper documentation in Compliance?
1.Protect our ___________________
2.Protect your ___________________
3.Protect the ___________________
- correct answer 1.Protect our programs
2.Protect your patients
3.Protect the Provider
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
,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.
What is the appeals process is the appeal decision by the Office of Medicare Hearings and Appeals
(OMHA)?
Frist level - _________________________
Second level - _________________________
Third appeal - _________________________
Fourth appeal - _________________________
Fifth appeal - _________________________
- correct answer 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
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
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
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 1128
- correct answer c. Balance Budget Act of 1997
Also known as a BBA "three strikes rule"
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
Life cycle of records management
C
U
M
R
D
- correct answer Creation
Use
Maintenance
Retention
Disposition
