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HCCA- CHC EXAM, PRACTICE EXAM AND STUDY
GUIDE NEWEST ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS WITH EXPLANATIONS
(VERIFIED ANSWERS) |ALREADY GRADED A+
Stark or Physician Self-Referral Law - (ANSWER)The Omnibus Budget
Reconciliation Act bans physicians from referring patients to receive "designated
health services" to any entity with which the physician has a financial relationship.
Designated health services include lab testing, imaging services, physical or
occupational therapy, etc. (civil only, medicare/medicaid only, strict liability)
Anti-Kickback Statute (AKS) - (ANSWER)Prohibits the solicitation, receiving,
offering, or paying any remuneration directly or indirectly in cash or in kind in
exchange. Essentially it prohibits the exchange of anything of value in exchange
for or in an effort to gain the referral of business reimbursable by federal
healthcare programs. (intent, any federal program, civil or criminal)
Physician Payments Sunshine Act (PPSA) - (ANSWER)Requires that detailed
information about payments or other "transfers of value" worth over $10 from
manufacturers of drugs, medical devices and biologics to physicians and teaching
hospitals be made available to the public. (Open payment data).
Deficit Reduction Act - (ANSWER)A Federal law that grants states the ability to
modify their Medicaid programs. This allows individual states to reform their
Medicaid programs to fit with the present health care environment while
maintaining federal guidelines.
False Claims Act - (ANSWER)Originally adopted byt U.S. Congress to discourage
suppliers from overcharging the government, it is now legislation that prohibits
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anyone from knowingly submitting or causing to be submitted a false or
fraudulent claim. DOJ.
Qui Tam Action - (ANSWER)Allows persons and entities with evidence of fraud
against federal programs or contracts to sue the wrongdoer on behalf of the
United States Government - based upon private information.
7 Elements of an Effective Compliance Program - (ANSWER)1. Policies and
Procedures
2. Compliance Oversight
3. Effective Lines of Communication
4. Training / Education
5. Internal Monitoring and Auditing
6. Enforcing standards through consistent disciplinary guidelines
7. Responding timely to detracted offenses.
HIPAA Privacy Rule - (ANSWER)A covered entity may not use of disclose
protected health information except for when it is required or permitted.
HIPAA Security Rule - (ANSWER)Essentially outlines how to protect PHI in an
electronic form (only applies to ePHI). 3 main safeguards: administrative,
technical, and physical.
Reportable Breach - (ANSWER)1. breach of privacy rule
HCCA- CHC EXAM, PRACTICE EXAM AND STUDY
GUIDE NEWEST ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS WITH EXPLANATIONS
(VERIFIED ANSWERS) |ALREADY GRADED A+
Stark or Physician Self-Referral Law - (ANSWER)The Omnibus Budget
Reconciliation Act bans physicians from referring patients to receive "designated
health services" to any entity with which the physician has a financial relationship.
Designated health services include lab testing, imaging services, physical or
occupational therapy, etc. (civil only, medicare/medicaid only, strict liability)
Anti-Kickback Statute (AKS) - (ANSWER)Prohibits the solicitation, receiving,
offering, or paying any remuneration directly or indirectly in cash or in kind in
exchange. Essentially it prohibits the exchange of anything of value in exchange
for or in an effort to gain the referral of business reimbursable by federal
healthcare programs. (intent, any federal program, civil or criminal)
Physician Payments Sunshine Act (PPSA) - (ANSWER)Requires that detailed
information about payments or other "transfers of value" worth over $10 from
manufacturers of drugs, medical devices and biologics to physicians and teaching
hospitals be made available to the public. (Open payment data).
Deficit Reduction Act - (ANSWER)A Federal law that grants states the ability to
modify their Medicaid programs. This allows individual states to reform their
Medicaid programs to fit with the present health care environment while
maintaining federal guidelines.
False Claims Act - (ANSWER)Originally adopted byt U.S. Congress to discourage
suppliers from overcharging the government, it is now legislation that prohibits
, 2
anyone from knowingly submitting or causing to be submitted a false or
fraudulent claim. DOJ.
Qui Tam Action - (ANSWER)Allows persons and entities with evidence of fraud
against federal programs or contracts to sue the wrongdoer on behalf of the
United States Government - based upon private information.
7 Elements of an Effective Compliance Program - (ANSWER)1. Policies and
Procedures
2. Compliance Oversight
3. Effective Lines of Communication
4. Training / Education
5. Internal Monitoring and Auditing
6. Enforcing standards through consistent disciplinary guidelines
7. Responding timely to detracted offenses.
HIPAA Privacy Rule - (ANSWER)A covered entity may not use of disclose
protected health information except for when it is required or permitted.
HIPAA Security Rule - (ANSWER)Essentially outlines how to protect PHI in an
electronic form (only applies to ePHI). 3 main safeguards: administrative,
technical, and physical.
Reportable Breach - (ANSWER)1. breach of privacy rule
