HCCA - CHC Study Questions with Verified Answers

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). True ref. ACA section 6102 According to HHS-OIG - what are three important reasons for proper documentation in Compliance? (hint: protections) 1.Protect our programs 2.Protect your patients 3.Protect the Provider #:~:text=Proper%20documentation%2C%20both%20in%20patients,to%20protect%20y ou%20the%20provider. 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 c. . third level of appeal 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 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. a. Leadership skills,c. Skills to design and implement a compliance program, and d. Be able to anticipate new risk areas. 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 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 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 policiesb. increasing management involvement c. responding to compliance hotline calls d. monitoring the code of conduct 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 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. 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 c. Policy document CAP - outlines corrective action plan Procedure - describes process/steps under a certain criteria Legal standards - mandatory action or rule Life cycle of records management Creation Use Maintenance RetentionDisposition Standards of Conduct (written P&Ps) Demonstrate the organization's ethical attitude and its "enterprise-wide" emphasis on compliance with all applicable laws and regulations Code of Conduct: Content Checklist • Demonstrate system wide emphasis on compliance with all applicable laws and regulations • Written plainly and concisely so all employees can understand the standards • Includes internal and external regulations • Mentions organizational policies without completely restating them • Is consistent with company policies and procedures • Includes management's responsibility to explain and enforce the code Ref: SCCE Compliance & Ethics Manual, Chapter 2 Code of Conduct and Employees All employees must receive, read, and understand the standards. A supervisor should explain the standards and answer any questions.Employee should attest in writing that they have received, read, and understood the standards Employee compliance with standards must be enforced through appropriate discipline when necessary Discipline for non-compliance should be stated in the standards Code of Conduct Purpose • To present specific guidelines for employees to follow • To confirm that all employees comprehend what is required of them • To provide a process for proper decision making • To confirm that employees put standards into everyday practice • To elevate corporate performance in basic business relationship • To confirm that the organization upholds and supports proper compliance conduct Every organization needs policies and procedures for: • Internal assessments • Record retention (where, how long) • Self-disclosure