HCA Certification Training Questions
and Answers (Verified)
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
A compliance program at its most basic level would be: - ANSWER-A set of internal
policies and procedures that you put into place to help your organization comply with
the law
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 hospital medical staff office is conducting its monthly review of the Excluded Parties
List System (EPLS). The compliance officer is called by the manager of the medical
staff office and informed that Dr. Smith, a surgeon who took call 5 times last month for
the Emergency Department, was excluded on a date prior to those dates when the
surgeon took call. In other words, the effective date of the exclusion involving the
surgeon was 4/1/2019 and the surgeon took call and provided surgical services to
patients in the ED on 4/13/19, 4/20/19, and 4/27/2019. What is the NEXT action the
compliance officer should do?
a. Contact the ED and make sure that the involved surgeon is removed from taking any
more on call shifts.
b. Have the medical office check if the surgeon is listed on other exclusion lists.
c. Contact legal counsel to alert of the need to pay back reimbursement received for
services provided by an excluded - ANSWER-b. Have the medical office check if the
surgeon is listed on other exclusion lists.
A provider intentionally upcodes services to a higher level in order to receive a larger
reimbursement from Medicare/Medicaid. Is this violation fraud, abuse, or neither?
a. Fraud
,b. Abuse
c. Neither - ANSWER-a. Fraud
ABC Hospital is under a 5-year CIA with government-imposed requirements for
development of a Compliance Program and use of external auditor for periodic claim
reviews.
Which of the following is TRUE:
a. Costs to meeting terms of the CIA are permitted to be included in the cost report like
any other operational cost.
b. Because the hospital agreed to a settlement and was not convicted for alleged
violations, the Compliance Program is considered a voluntary program.
c. The government chooses and pays for the external auditors.
d. None of the above - ANSWER-d. None of the above.
Explanation:
1. CIA-related costs CANNOT be included in the cost report.
2. Government-imposed Compliance Program ARE NOT considered a voluntary
program.
3. Hospital is required to choose and pay for any auditors (with government review and
right to object)
According to HHS-OIG - what are three important reasons for proper documentation in
Compliance?
1.Protect our ___________________
2.Protect your ___________________
3.Protect the ___________________ - ANSWER-1.Protect our programs
2.Protect your patients
3.Protect the Provider
An employee reports a potential problem with the attending physician's presence for
surgery. Which of the following is the compliance professional's BEST action?
a. investigate the issue
b. approach the surgeon
c. notify the OIG
d. request copies of the records - ANSWER-a. investigate the issue
Any laboratory performing testing on specimens derived from a human being for
purposes of providing diagnosis, prevention, treatment, or assessment of health,
regardless of whether they participate in Medicare, must:
a. Participate in a quality assurance program
b. Maintain adequate hours of operation for the underserved community
c. Enroll in the CLIA program
, d. Have a certificate of compliance - ANSWER-c. Enroll in the CLIA program
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 - ANSWER-c. third level of appeal
Because of the changing nature of healthcare regulation, which statement is TRUE
regarding updating the compliance program?
a. The compliance program should only be updated annually to ensure all the changed
regulations are captured.
b. The compliance program should be updated biannually.
c. Hiring a consultant to review the program for accuracy is necessary.
d. The compliance program should be continually a work in progress - ANSWER-d. The
compliance program should be continually a work in progress.
Code of Conduct: Content Checklist
1. Demonstrate ___________ _______ emphasis on _____________________ with all
applicable laws and regulations
2. _____________ plainly and concisely so all employees can understand the
standards
3. Includes ______________ and ______________ regulations
4. Mentions organizational ______________ without completely restating them
5. Is ______________ with company policies and procedures
6. Includes management's ___________________ to explain and enforce the code -
ANSWER-1. Demonstrate system wide emphasis on compliance with all applicable
laws and regulations
2. Written plainly and concisely so all employees can understand the standards
3. Includes internal and external regulations
4. Mentions organizational policies without completely restating them
5. Is consistent with company policies and procedures
6. Includes management's responsibility to explain and enforce the code
Code of Conduct: Employee Application
1. All employees must ______________ , ______________ , and ______________ the
standards.
2. A ______________ should explain the standards and answer any questions.
3. Employee should ______________ in ______________ that they have received,
read, and understood the standards
4. Employee compliance with standards must be ______________ through appropriate
______________ when necessary
and Answers (Verified)
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
A compliance program at its most basic level would be: - ANSWER-A set of internal
policies and procedures that you put into place to help your organization comply with
the law
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 hospital medical staff office is conducting its monthly review of the Excluded Parties
List System (EPLS). The compliance officer is called by the manager of the medical
staff office and informed that Dr. Smith, a surgeon who took call 5 times last month for
the Emergency Department, was excluded on a date prior to those dates when the
surgeon took call. In other words, the effective date of the exclusion involving the
surgeon was 4/1/2019 and the surgeon took call and provided surgical services to
patients in the ED on 4/13/19, 4/20/19, and 4/27/2019. What is the NEXT action the
compliance officer should do?
a. Contact the ED and make sure that the involved surgeon is removed from taking any
more on call shifts.
b. Have the medical office check if the surgeon is listed on other exclusion lists.
c. Contact legal counsel to alert of the need to pay back reimbursement received for
services provided by an excluded - ANSWER-b. Have the medical office check if the
surgeon is listed on other exclusion lists.
A provider intentionally upcodes services to a higher level in order to receive a larger
reimbursement from Medicare/Medicaid. Is this violation fraud, abuse, or neither?
a. Fraud
,b. Abuse
c. Neither - ANSWER-a. Fraud
ABC Hospital is under a 5-year CIA with government-imposed requirements for
development of a Compliance Program and use of external auditor for periodic claim
reviews.
Which of the following is TRUE:
a. Costs to meeting terms of the CIA are permitted to be included in the cost report like
any other operational cost.
b. Because the hospital agreed to a settlement and was not convicted for alleged
violations, the Compliance Program is considered a voluntary program.
c. The government chooses and pays for the external auditors.
d. None of the above - ANSWER-d. None of the above.
Explanation:
1. CIA-related costs CANNOT be included in the cost report.
2. Government-imposed Compliance Program ARE NOT considered a voluntary
program.
3. Hospital is required to choose and pay for any auditors (with government review and
right to object)
According to HHS-OIG - what are three important reasons for proper documentation in
Compliance?
1.Protect our ___________________
2.Protect your ___________________
3.Protect the ___________________ - ANSWER-1.Protect our programs
2.Protect your patients
3.Protect the Provider
An employee reports a potential problem with the attending physician's presence for
surgery. Which of the following is the compliance professional's BEST action?
a. investigate the issue
b. approach the surgeon
c. notify the OIG
d. request copies of the records - ANSWER-a. investigate the issue
Any laboratory performing testing on specimens derived from a human being for
purposes of providing diagnosis, prevention, treatment, or assessment of health,
regardless of whether they participate in Medicare, must:
a. Participate in a quality assurance program
b. Maintain adequate hours of operation for the underserved community
c. Enroll in the CLIA program
, d. Have a certificate of compliance - ANSWER-c. Enroll in the CLIA program
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 - ANSWER-c. third level of appeal
Because of the changing nature of healthcare regulation, which statement is TRUE
regarding updating the compliance program?
a. The compliance program should only be updated annually to ensure all the changed
regulations are captured.
b. The compliance program should be updated biannually.
c. Hiring a consultant to review the program for accuracy is necessary.
d. The compliance program should be continually a work in progress - ANSWER-d. The
compliance program should be continually a work in progress.
Code of Conduct: Content Checklist
1. Demonstrate ___________ _______ emphasis on _____________________ with all
applicable laws and regulations
2. _____________ plainly and concisely so all employees can understand the
standards
3. Includes ______________ and ______________ regulations
4. Mentions organizational ______________ without completely restating them
5. Is ______________ with company policies and procedures
6. Includes management's ___________________ to explain and enforce the code -
ANSWER-1. Demonstrate system wide emphasis on compliance with all applicable
laws and regulations
2. Written plainly and concisely so all employees can understand the standards
3. Includes internal and external regulations
4. Mentions organizational policies without completely restating them
5. Is consistent with company policies and procedures
6. Includes management's responsibility to explain and enforce the code
Code of Conduct: Employee Application
1. All employees must ______________ , ______________ , and ______________ the
standards.
2. A ______________ should explain the standards and answer any questions.
3. Employee should ______________ in ______________ that they have received,
read, and understood the standards
4. Employee compliance with standards must be ______________ through appropriate
______________ when necessary
