CHC - CCB Practice Test-Answered

Organizations receiving more than $5 million in Medicaid funds must provide education on the False Claims Act (FCA) in accordance with the: a. Stark Laws b. Deficit Reduction Act (DRA) c. Anti-Kickback (AKS) Law d. Sherman Antitrust Law - Answer- b. Deficit Reduction Act (DRA) An Organization identifies a potential issue when reviewing personal services and management contracts. Which of the following should the compliance professional consider in analyzing the issue? a. Deficit Reduction Act (DRA) b. Conditions of Participation (CoP) c. IRS tax-exempt guidelines d. Anti-Kickback (AKS) Safe Harbors - Answer- d. Anti-Kickback (AKS) Safe Harbors A hotline caller states the coding department was instructed to code based on LCD requirements regardless of medical record information. Which of the following should be the compliance professional's FIRST action? a. direct the coding supervisor to follow the applicable policy b. incorporate the coding issue into next year's risk assessment c. design a review to find facts and circumstances related to the compliant d. engage outside counsel to protect the underlying facts from discovery - Answer- c. design a review to find facts and circumstances related to the compliant In development of the annual work plan, physician contract compliance was prioritized as a high-risk area. When the compliance professional followed up with management, it appeared that the monitoring identified for this area was never put into place. Which of the following should be the compliance professional's FIRST step? a. Develop a corrective action plan b. Identify a statistically valid sample c. Conduct a probe sample d. Notify legal counsel - Answer- c. Conduct a probe sample A compliance professional identified an issue with medical necessity. The compliance professional should collaborate with the: a. case manager b. billing clerk c. documentation specialist d. patient account representative - Answer- a. case manager When non-compliance is substantiated, disciplinary action should be administered a. within 30 days b. if intent is proven c. in a consistent manner d. after completion of corrective action - Answer- c. in a consistent manner Which of the following is the BEST question to include in an employee exit interview? a. Why are you leaving your job? b. Did you ever observe anything that made you feel uncomfortable? c. How many times did you use the compliance hotline? d. Do you think your patients knew about the hotline? - Answer- b. Did you ever observe anything that made you feel uncomfortable? A compliance professional is conducting a policy review. Which of the following procedures MUST be included in the policy for statistically valid sampling and extrapolation? a. financial error rate exceeds 5% with a refund to occur within 60 days b. financial error rate exceeds 5% with a refund to occur within 90 days c. coding error rate exceeds 5% with a refund to occur within 60 days d. coding error rate exceeds 5% with a refund to occur within 90 days - Answer- a. financial error rate exceeds 5% with a refund to occur within 60 days Incentive programs based on employee performance may be tied to increases in a. the case mix index b. CPT/DRG codes c. patient referrals d. patient satisfaction - Answer- d. patient satisfaction A preliminary investigation identified payments to physicians for medical directorship without written contracts. Which of the following should be the compliance professional's NEXT step? a. determine if Medicare payments were received b. initiate a voluntary disclosure c. provide education to contracting office d. refund payments to the contractors - Answer- a. determine if Medicare payments were received In an investigation, the MOST important responsibility of the compliance professional is to a. personally conduct all investigations b. assure independence in investigations c. set the scope and sample size related to investigations d. remain within the budget for investigations - Answer- c. set the scope and sample size related to investigations A compliance professional discovers non-compliance with a regulation. Which of the following the compliance professional do FIRST? a. implement disciplinary actions b. conduct a baseline audit c. include it in the annual work plan d. develop a risk specific education plan - Answer- b. conduct a baseline audit A record retention policy