CHC RANDOM STUDY QUESTIONS 2
WITH ACCURATE SOLUTIONS
Affordable Care
Pursuant to 42 C.F.R. §§ 422.503(b)(4)(vi), 423.504(b)(4)(vi), and as incorporated into
Chapter 21, Section 30 of the "Medicare Managed Care Manual":
All sponsors are required to adopt and implement an effective compliance program,
which must include measures to prevent, detect and correct Part C or D program
noncompliance as well as FWA. The compliance program must, at a minimum, include
the following core requirements: 1. Written Policies, Procedures and Standards of
Conduct; 2. Compliance Officer, Compliance Committee and High Level Oversight; 3.
Effective Training and Education; 4. Effective Lines of Communication; 5. Well
Publicized Disciplinary Standards; 6. Effective System for Routine Monitoring and
Identification of Compliance Risks; and 7. Procedures and System for Prompt
Response to Compliance Issues.
These seven elements are functionally equivalent to the seven elements of an effective
co - correct answers ✔✔Fill in the blank:
,The ___________ ____ Act further required that the HHS Secretary, in consultation
with HHS-OIG, establish "core elements" for provider and supplier compliance
programs within a particular industry or sector.
conduct;
contractors - correct answers ✔✔Fill in the blanks:
The OIG CPG states: Standards of _______ should articulate hospital's commitment to
comply with Federal and state standards..... they should state the organization's
mission, goals, and ethical requirements of compliance and reflect a carefully crafted,
clear expression of expectations for all hospital governing body members, officers,
managers, employees, physicians, and, where appropriate, _______ and other agents.
c. Rewrite the CoC in plain and concise language tailored to the hospital so employees
can use a general guidance.
Explanation:
CoC should be clear and concise language easy to understand, and should be tailored
to specific issues of the organization - correct answers ✔✔You are the new Compliance
Officer, hired after ABC Hospital reorganized and decided that the General Counsel
should no longer also serve in that role. Upon review of the Code of Conduct (CoC), you
find that it is written using lots of legal jargon. What action do you take:
a. Keep CoC as it is.
b. Pull a sample off the internet and insert hospital name to save time as it was most
likely written by experts.
c. Rewrite the CoC in plain and concise language tailored to the hospital so employees
can use a general guidance.
d. Rewrite the CoC with detailed restating hospital's P&Ps, and all laws and regulations
possible so that employees can't say they were not aware of requirements.
a. c. and d. - correct answers ✔✔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.
Creation
Use
Maintenance
Retention
Disposition - correct answers ✔✔Life cycle of records management
OIG recommends: perform background checks, reference checks, and exclusion list
checks - correct answers ✔✔New Employee Policy - three checks OIG recommends to
do/perform:
, b. OIG - correct answers ✔✔Which of the following is responsible for clinical trial billing
compliance and enforcement:
a. FDA
b. OIG
c. ORI
d. OCR
d. None of the above.
Explanation:
• CIA-related costs CANNOT be included in the cost report.
• Government-imposed Compliance Program ARE NOT considered a voluntary
program.
• Hospital is required to choose and pay for any auditors (with government review and
right to object) - correct answers ✔✔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
b. The net financial error rate calculated was under 10%, no need to conduct a Full
Sample
According to the OIG, a Full Sample size is only required if the net financial error rate of
the Discovery Sample equals or exceeds 5%.
https://oig.hhs.gov/faqs/corporate-integrity-agreements-faq.asp - correct answers
✔✔The IRO is conducting a Claim Review for a hospital under a CIA and discovers that
there is a discrepancy between the dollar difference between the amount that was
reimbursed and the amount that should have been reimbursed when conducting a
Discovery Sample. Which of the following is false:
a. The dollar difference resulted in an overpayment. And when converted to percentage,
the resulting calculation is the error rate
b. The net financial error rate calculated was under 10%, no need to conduct a Full
Sample
c. If the net financial error rate of the Discovery Sample is below 5%, the review is
complete
d. A and C
Date of OIG open letter to all providers - encourages health care organization to
implement compliance programs in order to protect themselves from fraud and abuse.
With that letter, Model compliance plan for Clinical Laboratory was offered as guidance.
WITH ACCURATE SOLUTIONS
Affordable Care
Pursuant to 42 C.F.R. §§ 422.503(b)(4)(vi), 423.504(b)(4)(vi), and as incorporated into
Chapter 21, Section 30 of the "Medicare Managed Care Manual":
All sponsors are required to adopt and implement an effective compliance program,
which must include measures to prevent, detect and correct Part C or D program
noncompliance as well as FWA. The compliance program must, at a minimum, include
the following core requirements: 1. Written Policies, Procedures and Standards of
Conduct; 2. Compliance Officer, Compliance Committee and High Level Oversight; 3.
Effective Training and Education; 4. Effective Lines of Communication; 5. Well
Publicized Disciplinary Standards; 6. Effective System for Routine Monitoring and
Identification of Compliance Risks; and 7. Procedures and System for Prompt
Response to Compliance Issues.
These seven elements are functionally equivalent to the seven elements of an effective
co - correct answers ✔✔Fill in the blank:
,The ___________ ____ Act further required that the HHS Secretary, in consultation
with HHS-OIG, establish "core elements" for provider and supplier compliance
programs within a particular industry or sector.
conduct;
contractors - correct answers ✔✔Fill in the blanks:
The OIG CPG states: Standards of _______ should articulate hospital's commitment to
comply with Federal and state standards..... they should state the organization's
mission, goals, and ethical requirements of compliance and reflect a carefully crafted,
clear expression of expectations for all hospital governing body members, officers,
managers, employees, physicians, and, where appropriate, _______ and other agents.
c. Rewrite the CoC in plain and concise language tailored to the hospital so employees
can use a general guidance.
Explanation:
CoC should be clear and concise language easy to understand, and should be tailored
to specific issues of the organization - correct answers ✔✔You are the new Compliance
Officer, hired after ABC Hospital reorganized and decided that the General Counsel
should no longer also serve in that role. Upon review of the Code of Conduct (CoC), you
find that it is written using lots of legal jargon. What action do you take:
a. Keep CoC as it is.
b. Pull a sample off the internet and insert hospital name to save time as it was most
likely written by experts.
c. Rewrite the CoC in plain and concise language tailored to the hospital so employees
can use a general guidance.
d. Rewrite the CoC with detailed restating hospital's P&Ps, and all laws and regulations
possible so that employees can't say they were not aware of requirements.
a. c. and d. - correct answers ✔✔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.
Creation
Use
Maintenance
Retention
Disposition - correct answers ✔✔Life cycle of records management
OIG recommends: perform background checks, reference checks, and exclusion list
checks - correct answers ✔✔New Employee Policy - three checks OIG recommends to
do/perform:
, b. OIG - correct answers ✔✔Which of the following is responsible for clinical trial billing
compliance and enforcement:
a. FDA
b. OIG
c. ORI
d. OCR
d. None of the above.
Explanation:
• CIA-related costs CANNOT be included in the cost report.
• Government-imposed Compliance Program ARE NOT considered a voluntary
program.
• Hospital is required to choose and pay for any auditors (with government review and
right to object) - correct answers ✔✔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
b. The net financial error rate calculated was under 10%, no need to conduct a Full
Sample
According to the OIG, a Full Sample size is only required if the net financial error rate of
the Discovery Sample equals or exceeds 5%.
https://oig.hhs.gov/faqs/corporate-integrity-agreements-faq.asp - correct answers
✔✔The IRO is conducting a Claim Review for a hospital under a CIA and discovers that
there is a discrepancy between the dollar difference between the amount that was
reimbursed and the amount that should have been reimbursed when conducting a
Discovery Sample. Which of the following is false:
a. The dollar difference resulted in an overpayment. And when converted to percentage,
the resulting calculation is the error rate
b. The net financial error rate calculated was under 10%, no need to conduct a Full
Sample
c. If the net financial error rate of the Discovery Sample is below 5%, the review is
complete
d. A and C
Date of OIG open letter to all providers - encourages health care organization to
implement compliance programs in order to protect themselves from fraud and abuse.
With that letter, Model compliance plan for Clinical Laboratory was offered as guidance.
