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TruewsorwsFalse:
ThewsACAwsrequireswsthatwsallwsproviderswsadoptwsawscompliancewsplanwsaswsawsconditionwsofwse
nrollmentwswithwsMedicare,wsMedicaid,wsandwsChildren'swsHealthwsInsurancewsProgramws(CHIP
).ws-wsANSWER-True

ref.wsACAwssectionws6102

AccordingwstowsHHS-OIGws-
wswhat wsarewsthreewsimportantwsreasonswsforwsproperwsdocumentationwsin wsCompliance?ws(hint:ws

protections)ws-wsANSWER-1.Protectwsourwsprograms
2. Protectwsyourwspatients
3. ProtectwsthewsProvider

https://oig.hhs.gov/newsroom/podcasts/2011/heat/heat09-
wstrans.asp#:~:text=Proper%20documentation%2C%20both%20in%20patients,to%20protw

sect%20you%20the%20provider.




AtwswhichwslevelwsofwsthewsMedicarewsPartwsAwsorwsPartwsBwsappealswsprocesswsiswsthewsappealwsde
cisionwsbywsthewsOfficewsofwsMedicarewsHearingswsandwsAppealsws(OMHA)?
a. firstwslevelwsofwsappeal
b. secondwslevelwsofwsappeal
c. thirdwslevelwsofwsappeal
d. fourthwslevelwsofwsappealws-wsANSWER-c.ws.wsthirdwslevelwsofwsappeal

Fristwslevelws-
wsredeterminationwsbywsMedicarewscontractorwsSecondwslevel

ws-

wsreconsiderationwsbywsIndependentwscontractorwsThirdwsappe

alws-
wsAdministrativewsLawwsJudgews(ALJ)wshearingwsFourthwsappe

alws-
wsreviewwsbywsMedicarewsAppealswsCouncilw s Fifthwsappealws-

wsreviewwsin wsFederalwsDistrictwsCourt

https://www.hhs.gov/about/agencies/omha/the-appeals-process/index.html

WhatwsshouldwsCCOwsbewsablewstowsdo?ws(Whatwsskillswsshouldwsthiswspersonwshave?)wsChoosews
allwsthatwsapply.
a. Leadershipwsskills.
b. Overseewsthewscodingwsdepartment.
c. Skillswstowsdesignwsandwsimplementwsawscompliancewsprogram.
d. Bewsablewstowsanticipatewsnewwsriskwsareas.
e. Practicalwsexperiencewswithwsdocumentingwsmedicalwsnecessity.ws-wsANSWER-
a.wsLeadershipwsskills,

,c.wsSkillswstowsdesignwsandwsimplementwsawscompliancewsprogram,wsand
d.wsBewsablewstowsanticipatewsnewwsriskwsareas.

Whichwsofwsthewsfollowingwsiswsanwsabsolutewsnecessitywsinwsorderwstowshavewsawssuccessfulw
sCompliancewsProgram?

a. continuouswstrainingwsandwsimprovements
b. effectivewsreportingwspath
c. non-retaliationwsforwswhistleblowers
d. reliablewsandwsequalwsdisciplinews-wsANSWER-c.wsnon-retaliationwsforwswhistleblowers

AwsCompliancewsProgramwswithwswellwswrittenwspolicieswsandwsprocedures:
a. canwsbewssuccessfulwsifwsconsistentlywsreviewedwsandwsmaintained
b. cannotwsbewseffectivewsduewstowsthewssheerwsvolumewspresented
c. willwsbewseffectivewsifwsreadwsbywsmanagement
d. willwsnotwsbewssuccessfulwswithoutwsthewsproperwsoversightws-wsANSWER-
d.wswillwsnotwsbewssuccessfulwswithoutwsthewsproperwsoversight

AwsCompliancewsOfficerwscanwsachievewsawshigherwslevelwsofwscompliancewsandwsethicswsengage
mentwsby:
a. ensuringwsleadershipwsreadswsthewspolicies
b. increasingwsmanagementwsinvolvement
c. respondingwstowscompliancewshotlinewscalls
d. monitoringwsthewscodewsofwsconductws-wsANSWER-
b.wsincreasingwsmanagementwsinvolvement

Whichwsofwsthewsfollowingwsrequireswsproviderswstowsbewspermanentlywsexcludedwsfromwsallwsfede
ralwshealthwscarewsprogramswsifwsfoundwsguiltywsofwsawshealthcarewsrelatedwsfraudwsawsthirdwstime:
a. DeficitwsReductionwsActwsofws2005
b. FalsewsClaimswsAct
c. BalancewsBudgetwsActwsofws1997
d. SocialwsSecuritywsActwssectionws1128ws-wsANSWER-c.wsBalancewsBudgetwsActwsofws1997

AlsowsknownwsaswsawsBBAws"threewsstrikeswsrule"

WhichwsstatementwsiswsTRUEwsregardingwscompliancewsprograms?
a. Compliancewsprogramswsarewsconsideredwsmorewsdangerouswsifwstheywsarewsdevelopedwsb
utwsnotwsimplemented.
b. Compliancewsprogramswscanwsdetectwsbutwsnotwspreventwscriminalwsconduct
c. Compliancewsprogramswsarewsonlywsrequiredwsbywslawwsforwshealthcarewsentitieswsthatwshavew
smorewsthanws$500,000wsinwsannualwsrevenue.

d. Compliancewsprogramswsarewsnotwsmandatedwsbywslaw.ws-wsANSWER-
a.wsCompliancewsprogramswsarewsconsideredwsmorewsdangerouswsifwstheywsarewsdevelopedwsbu
twsnotwsimplemented.

Formalwsstatementwsoutliningwsawsplanwsforwsawsspecifiedwssubjectwsarea.wsItwsusuallywsciteswsstat
ewsand/orwsfederalwsrequiredwsactionswsorwsstandards.
a. CAP
b. Procedurewsdocument

,c. Policywsdocument
d. Legalwsstandardsws-wsANSWER-c.wsPolicywsdocument

CAPws-wsoutlineswscorrectivewsactionwsplan
Procedurews-
wsdescribeswsprocess/stepswsunderwsa wscertainwscriteriawsLegalwsstand

ardsws-wsmandatorywsactionwsorwsrule

Lifewscyclewsofwsrecordswsmanagementws-wsANSWER-
CreationwsUse
MaintenancewsR
etentionwsDispos
ition

StandardswsofwsConductws(writtenwsP&Ps)ws-wsANSWER-
Demonstratewsthewsorganization'swsethicalwsattitudewsandwsitsws"enterprise-
wide"wsemphasiswsonwscompliancewswithwsallwsapplicablewslawswsandwsregulations

CodewsofwsConduct:wsContentwsChecklistws-wsANSWER-
•wsDemonstratewssystemwswidewsemphasiswsonwscompliancewswithwsallwsapplicablewslawswsandwsr
egulations
• Writtenwsplainlywsandwsconciselywssowsallwsemployeeswscanwsunderstandwsthewsstandards
• Includeswsinternalwsandwsexternalwsregulations
• Mentionswsorganizationalwspolicieswswithoutwscompletelywsrestatingwsthem
• Iswsconsistentwswithwscompanywspolicieswsandwsprocedures
• Includeswsmanagement'swsresponsibilitywstowsexplainwsandwsenforcewsthewscode

Ref:wsSCCEwsCompliancews&wsEthicswsManual,wsChapterws2wshttps://compliancecosmos.
org/essential-elements-effective-ethics-and-compliance-wsprogram

CodewsofwsConductwsandwsEmployeesws-wsANSWER-
Allwsemployeeswsmustwsreceive,wsread,wsandwsunderstandwsthewsstandards.
Awssupervisorwsshouldwsexplainwsthewsstandardswsandwsanswerwsanywsquestions.
Employeewsshouldwsattestwsinwswritingwsthatwstheywshavewsreceived,wsread,wsandwsunderstoodwsth
ewsstandards
Employeewscompliancewswithwsstandardswsmustwsbewsenforcedwsthroughwsappropriatewsdiscipli
newswhenwsnecessary
Disciplinewsforwsnon-compliancewsshouldwsbewsstatedwsinwsthewsstandards

CodewsofwsConductwsPurposews-wsANSWER-
•wsTowspresentwsspecificwsguidelineswsforwsemployeeswstowsfollow
• Towsconfirmwsthatwsallwsemployeeswscomprehendwswhatwsiswsrequiredwsofwsthem
• Towsprovidewsawsprocesswsforwsproperwsdecisionwsmaking
• Towsconfirmwsthatwsemployeeswsputwsstandardswsintowseverydaywspractice
• Towselevatewscorporatewsperformancewsinwsbasicwsbusinesswsrelationship
• Towsconfirmwsthatwsthewsorganizationwsupholdswsandwssupportswsproperwscompliancewsconduct

, Everywsorganizationwsneedswspolicieswsandwsprocedureswsfor:ws-wsANSWER-
•wsInternalwsassessments
• Recordwsretentionws(where,wshowwslong)
• Self-disclosure
• Medicarewssanctionwschecksws(LEIE)
• Billingwspolicies
• Creditwsbalance
• Nowschargewsvisits
• Incomplete/unsuccessfulwsprocedure
• Documentationwsrequirements

WhenwsshouldwsCodewsofwsConductwsbewsdistributedwstowsnewwsemployees?ws-wsANSWER-
Mustwsbewsdistributedwswithinws90wsdayswsofwshire

RAT-STATSwsis:ws(selectwsallwsthatwsapply)
a. statisticalwssoftwarewstowsselectwsrandomizedwssamples
b. governmentwsstatisticalwsrulewssoftwarewsdevelopedwsinwsthews1970s
c. freewshospitalwsstatisticalwssoftware
d. recommendedwsbywsOIG,wsCMSwsandwsotherwsagencieswstowsselectwsrandomwssam
plesws-wsANSWER-a.wsb.wsd.

Thewssoftwarewscanwsbewsusedwsbywsotherwsentitieswsotherwsthanwshospitals,wssowsoptionws"c."
wsiswsnotwspreciselywsaccurate,wsbutwsitwsiswsfreewsto wsusewsandwscanwsbewsdownloadedwshere:w

shttps://oig.hhs.gov/compliance/rat-stats/index.asp




Whatwsiswsthewstermwscalledwsforwsanwsorganization'swscommitmentwstowscompliancewsbyws
management,wsemployees,wsandwscontractors.wsStatementwsshouldwssummarizewsethi
calwsbehaviorwsandwslegalwsprincipleswsunderwswhichwsthewshealthcarewsorganizationwsop
erates?ws-wsANSWER-CodewsofwsConduct

Inwsthewscoursewsofwsanwsaudit,wsyouwsfindwsthatwsdisciplinarywsactionswsagainstwscertainwsphysi
cianswsandwshighwslevelwsexecutiveswsforwsnon-
compliancewsinwsthewsorganizationwshavewsbeenwsunfairwsandwsinconsistentwswithwscurrentwspol
iciesws&wsprocedures.wsWhatwsiswsyourwsfirstwscoursewsofwsaction
.a.wsWorkwswithwslegalwscounselwstowsenforcewsproperwsdisciplinarywsactions
b. GetwsHRwsinvolvedwsandwsrecommendwsthewsusewsofwsprogressivewsdisciplinewspolicies
c. Immediatelywsterminatewsthesewsindividuals
d. Getwslocalwsandwsfederalwslaborwsdepartmentwsinvolvedwsforwsunfairwsdiscipline.ws-
wsANSWER-

b.wsGetwsHRwsinvolvedwsandwsrecommendwsthewsusewsofwsprogressivewsdisciplinewspolicies

OIGwsrecommendswssettingwsforthwsthewsdegreeswsofwsdisciplinarywsactions.wsProgressivewsdisci
plinewsprovideswsawsstructurewsandwsawssetwsofwsdisciplinewsstandardswsforwsmanagers/superviso
rswstowsfollowwstowsensurewsdisciplinewsiswsfair,wsequitablewsandwsconsistent.

Documentationws-wsANSWER-•wsA&Mwsshouldwsbewsdocumented
• Findingswsshouldwsbewssharedwswithwsdeptwsmanagers