©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
HCCA - CHC Study Questions with 100% Correct 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). - Answer✔️✔️-True
ref. ACA section 6102
According to HHS-OIG - what are three important reasons for proper
documentation in Compliance? (hint: protections) - Answer✔️✔️-1.Protect
our programs
2.Protect your patients
3.Protect the Provider
https://oig.hhs.gov/newsroom/podcasts/2011/heat/heat09-
trans.asp#:~:text=Proper%20documentation%2C%20both%20in%20patient
s,to%20protect%20you%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
1
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
b. second level of appeal
c. third level of appeal
d. fourth level of appeal - Answer✔️✔️-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
https://www.hhs.gov/about/agencies/omha/the-appeals-
process/index.html
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. - Answer✔️✔️-
a. Leadership skills,
2
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
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 - Answer✔️✔️-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 - Answer✔️✔️-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 policies
b. increasing management involvement
3
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
c. responding to compliance hotline calls
d. monitoring the code of conduct - Answer✔️✔️-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 - Answer✔️✔️-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.
4
HCCA - CHC Study Questions with 100% Correct 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). - Answer✔️✔️-True
ref. ACA section 6102
According to HHS-OIG - what are three important reasons for proper
documentation in Compliance? (hint: protections) - Answer✔️✔️-1.Protect
our programs
2.Protect your patients
3.Protect the Provider
https://oig.hhs.gov/newsroom/podcasts/2011/heat/heat09-
trans.asp#:~:text=Proper%20documentation%2C%20both%20in%20patient
s,to%20protect%20you%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
1
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
b. second level of appeal
c. third level of appeal
d. fourth level of appeal - Answer✔️✔️-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
https://www.hhs.gov/about/agencies/omha/the-appeals-
process/index.html
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. - Answer✔️✔️-
a. Leadership skills,
2
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
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 - Answer✔️✔️-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 - Answer✔️✔️-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 policies
b. increasing management involvement
3
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
c. responding to compliance hotline calls
d. monitoring the code of conduct - Answer✔️✔️-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 - Answer✔️✔️-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.
4
