2023 CHC - CCB Practice Test

Organizations receiving more than $5 million in Medicaid funds must provide education on the False Claims Act (FCA) in accordance with the: a. Stark Laws b. Deficit Reduction Act (DRA) c. Anti-Kickback (AKS) Law d. Sherman Antitrust Law - ANSWER-b. Deficit Reduction Act (DRA) An Organization identifies a potential issue when reviewing personal services and management contracts. Which of the following should the compliance professional consider in analyzing the issue? a. Deficit Reduction Act (DRA) b. Conditions of Participation (CoP) c. IRS tax-exempt guidelines d. Anti-Kickback (AKS) Safe Harbors - ANSWER-d. Anti-Kickback (AKS) Safe Harbors A hotline caller states the coding department was instructed to code based on LCD requirements regardless of medical record information. Which of the following should be the compliance professional's FIRST action? a. direct the coding supervisor to follow the applicable policy b. incorporate the coding issue into next year's risk assessment c. design a review to find facts and circumstances related to the compliant d. engage outside counsel to protect the underlying facts from discovery - ANSWER-c. design a review to find facts and circumstances related to the compliant In development of the annual work plan, physician contract compliance was prioritized as a high-risk area. When the compliance professional followed up with management, it appeared that the monitoring identified for this area was never put into place. Which of the following should be the compliance professional's FIRST step? a. Develop a corrective action plan b. Identify a statistically valid sample c. Conduct a probe sample d. Notify legal counsel - ANSWER-c. Conduct a probe sample A compliance professional identified an issue with medical necessity. The compliance professional should collaborate with the: a. case manager b. billing clerk c. documentation specialist d. patient account representative - ANSWER-a. case manager When non-compliance is substantiated, disciplinary action should be administered a. within 30 days b. if intent is proven