HCCA CHC FINAL EXAM ACTUAL QUESTIONS AND
ANSWERS GUARANTEE A+
✔✔HITECH - ✔✔Privacy laws related to electronic transmission of health information.
designed to encourage health care providers to adopt health information technology that
establish EHRs in a standardized manner that protects PHI. O
✔✔Occupational Safety and Health Administration (OSHA) - ✔✔A comment of DOL,
that develops and administers standards related to well-being of workers.
✔✔OCR (Office of Civil Rights) - ✔✔Component of DHHS, teaches workers bout health
information privacy, confidentiality laws, and investigates civil rights, health info privacy
compliance, and then enforces those regulations (Civilly).
✔✔safe harbors - ✔✔explicit regulatory exceptions to otherwise legally prohibited
conduct - they specify certain joint ventures and arrangements that do not violate laws.
✔✔Self-Reporting - ✔✔Having identified actual wrongdoing, the organization informs
the government. May offer mitigating factors to potential penalties and or fines.
✔✔Fraud - ✔✔intentional act of deception, misrepresentation, or concealment that is
done in order to gain something of value.
✔✔Waste - ✔✔using or expending carelessly, extravagantly, or to no purpose
✔✔Abuse - ✔✔intentional or unintentional practices that directly or indirectly result in
unnecessary or increased costs specifically to Medicare or Medicaid
✔✔Exclusion Statute - ✔✔explains why healthcare practitioners and entities can be
banned from participating in federal healthcare programs.
Mandatory exclusions - required if provider found guilty of felonies or criminal offenses
relating to fraud.
Permissible Exclusion - OIG has the discretionary power to decide to exclude providers
found guilty of other offenses.
✔✔Civil Monetary Penalties Law (CMPL) - ✔✔authorizes the OIG to impose civil money
penalties, assessments, and program exclusions to any person found guilty of
submitting fault for fraudulent claims.
✔✔Medicaid Fraud Control Units - ✔✔Operate in every state to investigate and
prosecute medicaid provider fraud, and patient abuse or neglect
, ✔✔Healthcare Fraud Prevention and Enforcement Action Teams (HEAT) - ✔✔Joint
initiative of the DOJ and HHS to raise the priority of medicare fraud enforcement
✔✔Voluntary Disclosure Program / Self Disclosure - ✔✔A program unveiled in 1998 by
the OIG that encourages healthcare providers to voluntarily report fraudulent conduct
affecting Medicare, Medicaid, and other federal healthcare programs
✔✔Probe Audit - ✔✔Designed to get an initial idea if further audit is needed - random
sample less than 30
✔✔Statistically Significant - ✔✔Sample size of 30 - as trends will repeat it self
✔✔Ethics - ✔✔the principles of right and wrong that guide an individual in making
decisions
✔✔Focused Training - ✔✔Focuses on particular topic for a specific group - for example
Stark training
✔✔General Training - ✔✔Training provided for all employees - such as training on
HIPAA, Hotline, Compliance Program.
✔✔OSHA employee rights - ✔✔request inspection, file complaint, have representation
during inspection, training, informed of hazards, request corrective action
✔✔How often to review policy? - ✔✔As often as policy on policies states - typically
recommended 2 years.
✔✔Code of Conduct - ✔✔a statement that guides the ethical behavior of a company
and its employees. Must include information on Fraud, Waste, Abuse, reporting, and
non-retaliation. Should be attested to annually.
✔✔Characteristics of Compliance Officer - ✔✔- independent
-high-level employee
-direct access to the board
✔✔Current Procedural Terminology (CPT) - ✔✔a medical code set maintained and
copyrighted by the American Medical Association that has been selected for use under
HIPAA for non-institutional and non-dental professional transactions
✔✔CPT Categories - ✔✔Category I = describes a procedure or service
Category II = Are supplemental tracking alpha-numeric codes that can be used for
performance measurement. The use of these codes is usually optional.
ANSWERS GUARANTEE A+
✔✔HITECH - ✔✔Privacy laws related to electronic transmission of health information.
designed to encourage health care providers to adopt health information technology that
establish EHRs in a standardized manner that protects PHI. O
✔✔Occupational Safety and Health Administration (OSHA) - ✔✔A comment of DOL,
that develops and administers standards related to well-being of workers.
✔✔OCR (Office of Civil Rights) - ✔✔Component of DHHS, teaches workers bout health
information privacy, confidentiality laws, and investigates civil rights, health info privacy
compliance, and then enforces those regulations (Civilly).
✔✔safe harbors - ✔✔explicit regulatory exceptions to otherwise legally prohibited
conduct - they specify certain joint ventures and arrangements that do not violate laws.
✔✔Self-Reporting - ✔✔Having identified actual wrongdoing, the organization informs
the government. May offer mitigating factors to potential penalties and or fines.
✔✔Fraud - ✔✔intentional act of deception, misrepresentation, or concealment that is
done in order to gain something of value.
✔✔Waste - ✔✔using or expending carelessly, extravagantly, or to no purpose
✔✔Abuse - ✔✔intentional or unintentional practices that directly or indirectly result in
unnecessary or increased costs specifically to Medicare or Medicaid
✔✔Exclusion Statute - ✔✔explains why healthcare practitioners and entities can be
banned from participating in federal healthcare programs.
Mandatory exclusions - required if provider found guilty of felonies or criminal offenses
relating to fraud.
Permissible Exclusion - OIG has the discretionary power to decide to exclude providers
found guilty of other offenses.
✔✔Civil Monetary Penalties Law (CMPL) - ✔✔authorizes the OIG to impose civil money
penalties, assessments, and program exclusions to any person found guilty of
submitting fault for fraudulent claims.
✔✔Medicaid Fraud Control Units - ✔✔Operate in every state to investigate and
prosecute medicaid provider fraud, and patient abuse or neglect
, ✔✔Healthcare Fraud Prevention and Enforcement Action Teams (HEAT) - ✔✔Joint
initiative of the DOJ and HHS to raise the priority of medicare fraud enforcement
✔✔Voluntary Disclosure Program / Self Disclosure - ✔✔A program unveiled in 1998 by
the OIG that encourages healthcare providers to voluntarily report fraudulent conduct
affecting Medicare, Medicaid, and other federal healthcare programs
✔✔Probe Audit - ✔✔Designed to get an initial idea if further audit is needed - random
sample less than 30
✔✔Statistically Significant - ✔✔Sample size of 30 - as trends will repeat it self
✔✔Ethics - ✔✔the principles of right and wrong that guide an individual in making
decisions
✔✔Focused Training - ✔✔Focuses on particular topic for a specific group - for example
Stark training
✔✔General Training - ✔✔Training provided for all employees - such as training on
HIPAA, Hotline, Compliance Program.
✔✔OSHA employee rights - ✔✔request inspection, file complaint, have representation
during inspection, training, informed of hazards, request corrective action
✔✔How often to review policy? - ✔✔As often as policy on policies states - typically
recommended 2 years.
✔✔Code of Conduct - ✔✔a statement that guides the ethical behavior of a company
and its employees. Must include information on Fraud, Waste, Abuse, reporting, and
non-retaliation. Should be attested to annually.
✔✔Characteristics of Compliance Officer - ✔✔- independent
-high-level employee
-direct access to the board
✔✔Current Procedural Terminology (CPT) - ✔✔a medical code set maintained and
copyrighted by the American Medical Association that has been selected for use under
HIPAA for non-institutional and non-dental professional transactions
✔✔CPT Categories - ✔✔Category I = describes a procedure or service
Category II = Are supplemental tracking alpha-numeric codes that can be used for
performance measurement. The use of these codes is usually optional.
