HCCA – CHC Study Questions – Master Flashcards for Certified in Healthcare Compliance Exam
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). - correct answer True
ref. ACA section 6102
According to HHS-OIG - what are three important reasons for proper documentation in
Compliance? (hint: protections) - correct 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%20patients,to%20protect%20
you%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 - correct 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.
,HCCA – CHC Study Questions – Master Flashcards for Certified in Healthcare Compliance Exam
c. Skills to design and implement a compliance program.
d. Be able to anticipate new risk areas.
e. Practical experience with documenting medical necessity. - correct answer 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 - correct 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 - correct 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
c. responding to compliance hotline calls
d. monitoring the code of conduct - correct 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
,HCCA – CHC Study Questions – Master Flashcards for Certified in Healthcare Compliance Exam
d. Social Security Act section 1128 - correct 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.
d. Compliance programs are not mandated by law. - correct answer 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 - correct answer 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 - correct answer Creation
Use
Maintenance
Retention
Disposition
Standards of Conduct (written P&Ps) - correct answer Demonstrate the organization's ethical
attitude and its "enterprise-wide" emphasis on compliance with all applicable laws and
regulations
, HCCA – CHC Study Questions – Master Flashcards for Certified in Healthcare Compliance Exam
Code of Conduct: Content Checklist - correct answer • 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
https://compliancecosmos.org/essential-elements-effective-ethics-and-compliance-program
Code of Conduct and Employees - correct answer 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 - correct answer • 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: - correct answer • Internal assessments
• Record retention (where, how long)
• Self-disclosure
• Medicare sanction checks (LEIE)
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). - correct answer True
ref. ACA section 6102
According to HHS-OIG - what are three important reasons for proper documentation in
Compliance? (hint: protections) - correct 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%20patients,to%20protect%20
you%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 - correct 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.
,HCCA – CHC Study Questions – Master Flashcards for Certified in Healthcare Compliance Exam
c. Skills to design and implement a compliance program.
d. Be able to anticipate new risk areas.
e. Practical experience with documenting medical necessity. - correct answer 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 - correct 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 - correct 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
c. responding to compliance hotline calls
d. monitoring the code of conduct - correct 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
,HCCA – CHC Study Questions – Master Flashcards for Certified in Healthcare Compliance Exam
d. Social Security Act section 1128 - correct 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.
d. Compliance programs are not mandated by law. - correct answer 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 - correct answer 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 - correct answer Creation
Use
Maintenance
Retention
Disposition
Standards of Conduct (written P&Ps) - correct answer Demonstrate the organization's ethical
attitude and its "enterprise-wide" emphasis on compliance with all applicable laws and
regulations
, HCCA – CHC Study Questions – Master Flashcards for Certified in Healthcare Compliance Exam
Code of Conduct: Content Checklist - correct answer • 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
https://compliancecosmos.org/essential-elements-effective-ethics-and-compliance-program
Code of Conduct and Employees - correct answer 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 - correct answer • 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: - correct answer • Internal assessments
• Record retention (where, how long)
• Self-disclosure
• Medicare sanction checks (LEIE)
