HCCA Test Questions And Answers With Verified Updates

What elements should your code of conduct include? - -Tone from the top -Alignment with the organizations, mission, vision, values, culture, and history -Brief and easily readable -Conceptually covers general principles of conduct applicable to all members of the organization -incorporation of real life examples -Conceptual approach to use your code of conduct should be inspiring, motivational, and encouraging Deficit Reduction Act of 2005 (FOR MEDICAID) - Requires entities that receive or make payments under a state Medicaid plan of at least $5 million to have a compliance program Compliance program staff needs- - Sufficient resources, investment, enough authority, access to data and people, diversity of skill set "The ""New Deal"" of the 1930s - Promoted growth of government/rulemaking 1942 War Labor Board - Wage freeze, fringe benefits up to 5% didn't count, employers started offering health insurance 1973 health maintenance organization (HMO) Act - $300 million to start up, managed care organizations; requires many employers to offer HMO coverage to employees 2010-present healthcare regulation - Electronic health record; affordable care act; accountable care organizations; health care exchange A code of conduct creates a standard of behavior that aligns all stakeholders to a ______ approach - Single Access to the board: - CCO should have direct access to the board and have regular meetingsAfter reporting the risk assessment to the board, what comes next? - Corrective action planning and implementation Benefits of a compliance program - Employee engagement, continuous process of improvement, good business practices to identify and prevent risks Best practices (code of conduct) - -Visually appealing -looks and feels like the organization with color schemes, logos, phrases, pictures of employees -Contact information for questions or concerns -Addresses key topics of interest/risk such as billing integrity, privacy of patient, information, physician, relations, workplace behavior -annual attestation of receipt, understanding, and adherence by key stakeholders -Refer to the code of conduct often when answering questions, addressing issues - use code of conduct as a resource Board of directors responsibility: - Knowledgeable about content and operation of compliance program and program oversight- help set the tone at the top CCO reports directly to: - CEO CCO- - Maintains credibility and integrity of the program Civil Monetary Penalties - Federal agencies were given authority to issue penalties to address noncompliance Compliance guidelines incorporate many concepts from the - Defense industry initiative Compliance programs become mandatory - 1998- Centers for Medicare and Medicaid Services (CMS) require such organizations to establish a plan for complying with all applicable federal and state standardsCompliance programs can vary based on - The size of the organization Compliance programs consider OIG guidance documents for a health care organization - -ethics -HIPAA -fraud and abuse laws (anti-kickback, stark law, unlawful patient inducement) -billing compliance (false claims act) -antitrust -foreign corrupt practices act -accreditation standards (sometimes) Compliance programs for Medicare advantage organizations need- - -governing body and senior leader oversight -written policies, procedures, and standards -designation of a compliance officer -annual training and education -effective communication including compliance hotline -timely, consistent, and effective enforcement of standards -routine monitoring, auditing, and risk analysis -response and prevention, including procedures to voluntarily self-report potential fraud or misconduct