CHST WORKSITE AUDIT EXAM SCRIPT 2026
QUESTIONS WITH ANSWERS GRADED A+
●● A billing manager is reviewing the monthly reimbursement report for
the department. The manager notices that there is an increase of 50%
over the expected amount of incoming payments from Federal health
care programs for treatment of patients. The manager believes action is
needed. The manager's NEXT step is to:
1. Stop all outgoing claims to Federal health care programs
2. Extrapolate the last 6 months of reimbursement totals to identify the
overpayment due to health care programs
3. Contact legal for next steps or further direction to include advice on
how to proceed with the self disclosure protocol
4. Analyze the details related to the increase in payments to identify
possible sources or causes for increase in reimbursement Answer: 4.
Analyze the details related to the increase in payments to identify
possible sources or causes for increase in reimbursement
●● If during the course of an internal investigation, the compliance
officer believes the integrity of the investigation might be compromised
by the continued presence of work force members who are the subject of
the investigation. In the best interest of the attorney-client privilege,
which action would you to take?
a. Conduct employee background checks
b. Counsel obtains employee's depositions
,c. Destroy documents and other evidence
d. Re-assign employees to other responsibilities until the investigation is
completed
e. All of the above Answer: d. Re-assign employees to other
responsibilities until the investigation is completed.
Explanation: he/she should recommend that such individuals be
temporarily removed from their current responsibilities until the
investigation is completed.
Ref. Healthcare Compliance Professional's Manual
●● A common reporting system, administered in house or by outside
consultants, giving anonymous telephone access to employees seeking to
report possible instances of wrongdoing Answer: Hotline or Helpline
●● Reporting systems should be:
a. marketed to contractors
b. outsourced to a vendor
c. operated by management
d. publicized to all employees Answer: d. publicized to all employees
●● A primary source of information for the team conducting an audit
would be:
a. OIG work Plan
, b. Organization's existing documents
c. CPT and ICD10 books
d. HCCA
e. Investigation Procedures
f. Promise of non-retaliation
g. Chain of command Answer: b. Organization's existing documents
●● CMS ______________ Programs:
1. are administered by individual states
2. some older adults have this program as a secondary insurance
3. provides health coverage to low income families and individuals
Answer: Medicaid
●● 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
Frist level - redetermination by Medicare contractor
Second level - reconsideration by Independent contractor
QUESTIONS WITH ANSWERS GRADED A+
●● A billing manager is reviewing the monthly reimbursement report for
the department. The manager notices that there is an increase of 50%
over the expected amount of incoming payments from Federal health
care programs for treatment of patients. The manager believes action is
needed. The manager's NEXT step is to:
1. Stop all outgoing claims to Federal health care programs
2. Extrapolate the last 6 months of reimbursement totals to identify the
overpayment due to health care programs
3. Contact legal for next steps or further direction to include advice on
how to proceed with the self disclosure protocol
4. Analyze the details related to the increase in payments to identify
possible sources or causes for increase in reimbursement Answer: 4.
Analyze the details related to the increase in payments to identify
possible sources or causes for increase in reimbursement
●● If during the course of an internal investigation, the compliance
officer believes the integrity of the investigation might be compromised
by the continued presence of work force members who are the subject of
the investigation. In the best interest of the attorney-client privilege,
which action would you to take?
a. Conduct employee background checks
b. Counsel obtains employee's depositions
,c. Destroy documents and other evidence
d. Re-assign employees to other responsibilities until the investigation is
completed
e. All of the above Answer: d. Re-assign employees to other
responsibilities until the investigation is completed.
Explanation: he/she should recommend that such individuals be
temporarily removed from their current responsibilities until the
investigation is completed.
Ref. Healthcare Compliance Professional's Manual
●● A common reporting system, administered in house or by outside
consultants, giving anonymous telephone access to employees seeking to
report possible instances of wrongdoing Answer: Hotline or Helpline
●● Reporting systems should be:
a. marketed to contractors
b. outsourced to a vendor
c. operated by management
d. publicized to all employees Answer: d. publicized to all employees
●● A primary source of information for the team conducting an audit
would be:
a. OIG work Plan
, b. Organization's existing documents
c. CPT and ICD10 books
d. HCCA
e. Investigation Procedures
f. Promise of non-retaliation
g. Chain of command Answer: b. Organization's existing documents
●● CMS ______________ Programs:
1. are administered by individual states
2. some older adults have this program as a secondary insurance
3. provides health coverage to low income families and individuals
Answer: Medicaid
●● 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
Frist level - redetermination by Medicare contractor
Second level - reconsideration by Independent contractor
