HCCA CHC EXAM PREP | 75 QUESTIONS AND ANSWERS |
2026 NEW UPDATE | WITH COMPLETE SOLUTION
Stark or Physician Self-Referral Law Answer - The Omnibus Budget
Reconciliation Act bans physicians from referring patients to receive
"designated health services" to any entity with which the physician has a
financial relationship. Designated health services include lab testing, imaging
services, physical or occupational therapy, etc. (civil only, medicare/medicaid
only, strict liability)
Anti-Kickback Statute (AKS) Answer - Prohibits the solicitation, receiving,
offering, or paying any remuneration directly or indirectly in cash or in kind in
exchange. Essentially it prohibits the exchange of anything of value in exchange
for or in an effort to gain the referral of business reimbursable by federal
healthcare programs. (intent, any federal program, civil or criminal)
Physician Payments Sunshine Act (PPSA) Answer - Requires that detailed
information about payments or other "transfers of value" worth over $10 from
manufacturers of drugs, medical devices and biologics to physicians and
teaching hospitals be made available to the public. (Open payment data).
Deficit Reduction Act Answer - A Federal law that grants states the ability to
modify their Medicaid programs. This allows individual states to reform their
Medicaid programs to fit with the present health care environment while
maintaining federal guidelines.
, False Claims Act Answer - Originally adopted byt U.S. Congress to discourage
suppliers from overcharging the government, it is now legislation that prohibits
anyone from knowingly submitting or causing to be submitted a false or
fraudulent claim. DOJ.
Qui Tam Action Answer - Allows persons and entities with evidence of fraud
against federal programs or contracts to sue the wrongdoer on behalf of the
United States Government - based upon private information.
7 Elements of an Effective Compliance Program Answer - 1. Policies and
Procedures
2. Compliance Oversight
3. Effective Lines of Communication
4. Training / Education
5. Internal Monitoring and Auditing
6. Enforcing standards through consistent disciplinary guidelines
7. Responding timely to detracted offenses.
HIPAA Privacy Rule Answer - A covered entity may not use of disclose
protected health information except for when it is required or permitted.
HIPAA Security Rule Answer - Essentially outlines how to protect PHI in an
electronic form (only applies to ePHI). 3 main safeguards: administrative,
technical, and physical.
Reportable Breach Answer - 1. breach of privacy rule
2. unsecured PHI
3. more than "low probability of compromise"
2026 NEW UPDATE | WITH COMPLETE SOLUTION
Stark or Physician Self-Referral Law Answer - The Omnibus Budget
Reconciliation Act bans physicians from referring patients to receive
"designated health services" to any entity with which the physician has a
financial relationship. Designated health services include lab testing, imaging
services, physical or occupational therapy, etc. (civil only, medicare/medicaid
only, strict liability)
Anti-Kickback Statute (AKS) Answer - Prohibits the solicitation, receiving,
offering, or paying any remuneration directly or indirectly in cash or in kind in
exchange. Essentially it prohibits the exchange of anything of value in exchange
for or in an effort to gain the referral of business reimbursable by federal
healthcare programs. (intent, any federal program, civil or criminal)
Physician Payments Sunshine Act (PPSA) Answer - Requires that detailed
information about payments or other "transfers of value" worth over $10 from
manufacturers of drugs, medical devices and biologics to physicians and
teaching hospitals be made available to the public. (Open payment data).
Deficit Reduction Act Answer - A Federal law that grants states the ability to
modify their Medicaid programs. This allows individual states to reform their
Medicaid programs to fit with the present health care environment while
maintaining federal guidelines.
, False Claims Act Answer - Originally adopted byt U.S. Congress to discourage
suppliers from overcharging the government, it is now legislation that prohibits
anyone from knowingly submitting or causing to be submitted a false or
fraudulent claim. DOJ.
Qui Tam Action Answer - Allows persons and entities with evidence of fraud
against federal programs or contracts to sue the wrongdoer on behalf of the
United States Government - based upon private information.
7 Elements of an Effective Compliance Program Answer - 1. Policies and
Procedures
2. Compliance Oversight
3. Effective Lines of Communication
4. Training / Education
5. Internal Monitoring and Auditing
6. Enforcing standards through consistent disciplinary guidelines
7. Responding timely to detracted offenses.
HIPAA Privacy Rule Answer - A covered entity may not use of disclose
protected health information except for when it is required or permitted.
HIPAA Security Rule Answer - Essentially outlines how to protect PHI in an
electronic form (only applies to ePHI). 3 main safeguards: administrative,
technical, and physical.
Reportable Breach Answer - 1. breach of privacy rule
2. unsecured PHI
3. more than "low probability of compromise"
