HCCA - CHC EXAM STUDY PACK 2025 - ACTUAL EXAM QUESTIONS WITH 100% VERIFIED SOLUTIONS - LATEST UPDATE 2025–2026 / A+ GRADE

Page 1 of 294



HCCA - CHC EXAM STUDY PACK 2025 –ACTUAL EXAM
QUESTIONS WITH 100% VERIFIED SOLUTIONS-
LATEST UPDATE 2025-2026/A+ GRADE

True or False:

The ACA requires that all providers adopt a compliance plan as a condition of enrollment with

Medicare, Medicaid, and Children's Health Insurance Program (CHIP).

✔✔True

ref. ACA section 6102


According to HHS-OIG - what are three important reasons for proper documentation in

Compliance? (hint: protections)

✔✔1.Protect our programs


2. Protect your patients

3. Protect the Provider



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)?

, Page 2 of 294


a. first level of appeal

b. second level of appeal

c. third level of appeal


d. fourth level of appeal

✔✔c. . third level of appeal

Frist level - redetermination by Medicare contractor

Second level - reconsideration by Independent contractor

Third appeal - Administrative Law Judge (ALJ) hearing

Fourth appeal - review by Medicare Appeals Council

Fifth appeal - review in Federal District Court

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


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.


✔✔a. Leadership skills,

, Page 3 of 294


c. Skills to design and implement a compliance program, and
Py Py Py Py Py Py Py Py Py




d. Be able to anticipate new risk areas.
Py Py Py Py Py Py Py




Which of the following is an absolute necessity in order to have a successful Compliance
Py Py Py Py Py Py Py Py Py Py Py Py Py Py




Program?
yP




a. continuous training and improvements Py Py Py




b. effective reporting path Py Py




c. non-retaliation for whistleblowers Py Py




d. reliable and equal discipline Py Py Py Py




✔✔c. non-retaliation for whistleblowers
Py Py Py




A Compliance Program with well written policies and procedures:
Py Py Py Py Py Py Py Py




a. can be successful if consistently reviewed and maintained
Py Py Py Py Py Py Py




b. cannot be effective due to the sheer volume presented
Py Py Py Py Py Py Py Py




c. will be effective if read by management
Py Py Py Py Py Py




d. will not be successful without the proper oversight
Py Py Py Py Py Py Py Py




✔✔d. will not be successful without the
Py Py Py Py Py Py




proper oversight Py




A Compliance Officer can achieve a higher level of compliance and ethics engagement by:
Py Py Py Py Py Py Py Py Py Py Py Py Py




a. ensuring leadership reads the policies
Py Py Py Py

, Page 4 of 294


b. increasing management involvement Py Py




c. responding to compliance hotline calls Py Py Py Py




d. monitoring the code of conduct Py Py Py Py Py




✔✔b. increasing management involvement
Py Py Py




Which of the following requires providers to be permanently excluded from all federal health
Py Py Py Py Py Py Py Py Py Py Py Py Py




care programs if found guilty of a healthcare related fraud a third time:
yP Py Py Py Py Py Py Py Py Py Py Py Py




a. Deficit Reduction Act of 2005 Py Py Py Py




b. False Claims Act Py Py




c. Balance Budget Act of 1997 Py Py Py Py




d. Social Security Act section 1128
Py Py Py Py




Py ✔✔c. Balance Budget Act of 1997
Py Py Py Py Py




Also known as a BBA "three strikes rule"
Py Py Py Py Py Py Py




Which statement is TRUE regarding compliance programs?
Py Py Py Py Py Py




a. Compliance programs are considered more dangerous if they are developed but
Py Py Py Py Py Py Py Py Py Py




Py notimplemented.
yP




b. Compliance programs can detect but not prevent criminal conduct
Py Py Py Py Py Py Py Py




c. Compliance programs are only required by law for healthcare entities that have more than
Py Py Py Py Py Py Py Py Py Py Py Py Py




$500,000 in annual revenue. Py Py Py