HCCAfp-fpCHCfpStudyfpQuestionsfpWithfpVerifiedfpAnswerfp
TruefporfpFalse:
ThefpACAfprequiresfpthatfpallfpprovidersfpadoptfpafpcompliancefpplanfpasfpafpconditionfpo
ffpenrollmentfpwithfpMedicare,fpMedicaid,fpandfpChildren'sfpHealthfpInsurancefpProgramfp(
CHIP).fp-fpTrue
ref.fpACAfpsectionfp6102
AccordingfptofpHHS-OIGfp-
fpwhatfparefpthreefpimportantfpreasonsfpforfpproperfpdocumentationfpinfpCompliance?
fp(hint:fpprotections)fp-fp1.Protectfpourfpprograms
2.Protectfpyourfppatients
3.ProtectfpthefpProvider
https://oig.hhs.gov/newsroom/podcasts/2011/heat/heat09-trans.asp#:~:text=Proper
%20documentation%2C%20both%20in%20patients,to%20protect%20you%20the%20provider.
AtfpwhichfplevelfpoffpthefpMedicarefpPartfpAfporfpPartfpBfpappealsfpprocessfpisfpthefpapp
ealfpdecisionfpbyfpthefpOfficefpoffpMedicarefpHearingsfpandfpAppealsfp(OMHA)?
a.fpfirstfplevelfpoffpappeal
b.fpsecondfplevelfpoffpappeal
c.fpthirdfplevelfpoffpappeal
d.fpfourthfplevelfpoffpappealfp-fpc.fp.fpthirdfplevelfpoffpappeal
Fristfplevelfp-fpredeterminationfpbyfpMedicarefpcontractor
,Secondfplevelfp-fpreconsiderationfpbyfpIndependentfpcontractor
Thirdfpappealfp-fpAdministrativefpLawfpJudgefp(ALJ)fphearing
Fourthfpappealfp-fpreviewfpbyfpMedicarefpAppealsfpCouncil
Fifthfpappealfp-fpreviewfpinfpFederalfpDistrictfpCourt
https://www.hhs.gov/about/agencies/omha/the-appeals-process/index.html
WhatfpshouldfpCCOfpbefpablefptofpdo?
fp(Whatfpskillsfpshouldfpthisfppersonfphave?)fpChoosefpallfpthatfpapply.
a.fpLeadershipfpskills.
b.fpOverseefpthefpcodingfpdepartment.
c.fpSkillsfptofpdesignfpandfpimplementfpafpcompliancefpprogram.
d.fpBefpablefptofpanticipatefpnewfpriskfpareas.
e.fpPracticalfpexperiencefpwithfpdocumentingfpmedicalfpnecessity.fp-fpa.fpLeadershipfpskills,
c.fpSkillsfptofpdesignfpandfpimplementfpafpcompliancefpprogram,fpand
d.fpBefpablefptofpanticipatefpnewfpriskfpareas.
Whichfpoffpthefpfollowingfpisfpanfpabsolutefpnecessityfpinfporderfptofphavefpafpsuccessfulf
pCompliancefpProgram?
a.fpcontinuousfptrainingfpandfpimprovements
b.fpeffectivefpreportingfppath
c.fpnon-retaliationfpforfpwhistleblowers
d.fpreliablefpandfpequalfpdisciplinefp-fpc.fpnon-retaliationfpforfpwhistleblowers
AfpCompliancefpProgramfpwithfpwellfpwrittenfppoliciesfpandfpprocedures:
a.fpcanfpbefpsuccessfulfpiffpconsistentlyfpreviewedfpandfpmaintained
b.fpcannotfpbefpeffectivefpduefptofpthefpsheerfpvolumefppresented
c.fpwillfpbefpeffectivefpiffpreadfpbyfpmanagement
,d.fpwillfpnotfpbefpsuccessfulfpwithoutfpthefpproperfpoversightfp-
fpd.fpwillfpnotfpbefpsuccessfulfpwithoutfpthefpproperfpoversight
Regardlessfpoffphavingfpthefpbestfpwrittenfppoliciesfpinfpplacefpthatfparefpreviewed/
maintainedfpconsistently,fpandfpreadfpandfpdisseminatedfpaccordingly,fpwillfpfailfpiffptheref
pisfpnofpproperfpoversightfptofpensurefptheyfparefpactuallyfpbeingfpfollowedfpandfpunderst
ood.
AfpCompliancefpOfficerfpcanfpachievefpafphigherfplevelfpoffpcompliancefpandfpethicsfpenga
gementfpby:
a.fpensuringfpleadershipfpreadsfpthefppolicies
b.fpincreasingfpmanagementfpinvolvement
c.fprespondingfptofpcompliancefphotlinefpcalls
d.fpmonitoringfpthefpcodefpoffpconductfp-fpb.fpincreasingfpmanagementfpinvolvement.
Compliancefpisfpeveryone'sfpresponsibility,fpbutfpmanagementfpinvolvementfpisfpcrucial.fpT
heyfphavefpafpdirectfpcontactfpwithfpemployees,fptheyfpknowfpandfpunderstandfptheirfpsta
ff'sfpneedsfpandfpconcerns,fpandfphavefpthefpmostfpinfluencefpoverfpemployee'sfpactionsfp
andfpattitudes.fpEmployeesfpmostfplikelyfpusefptheirfpdirectfpmanager(s)fptofpraisefpconcer
nsfpandfpthefpreasonfptheyfparefpsofpcriticalfpforfpanfporganizationfptofpfosterfpafpculturef
poffpcompliance.
Whichfpoffpthefpfollowingfprequiresfpprovidersfptofpbefppermanentlyfpexcludedfpfromfpallf
pfederalfphealthfpcarefpprogramsfpiffpfoundfpguiltyfpoffpafphealthcarefprelatedfpfraudfpafpt
hirdfptime:
a.fpDeficitfpReductionfpActfpoffp2005
b.fpFalsefpClaimsfpAct
c.fpBalancefpBudgetfpActfpoffp1997
d.fpSocialfpSecurityfpActfpsectionfp1128dfp-fpc.fpBalancefpBudgetfpActfpoffp1997
, AlsofpknownfpasfpafpBBAfp"threefpstrikesfprule"
WhatfpsectionfpoffpthefpACAfppreventsfpdiscriminationfpagainstfpindividualsfpwithfplimitedf
pEnglishfpproficiencyfp(LEP),fpandfpalsofpprohibitsfpdiscriminationfpinfphealthcarefpprogram
sfpandfpactivitiesfpthatfpreceivefpfederalfpfunding,fpbasedfponfprace,fpcolor,fpnationalfporig
in,fpsex,fpage,fporfpdisability.
a.fpACAfpsectionfp6102
b.fpACAfpsectionfp1557
c.fpACAfpsectionfp6002fp-fpb.fpACAfpsectionfp1557fpisfpthefpcorrectfpanswer.
a.fpACAfpsectionfp6102fprequiresfpowners,fpoperators,fpandfpadministratorsfpoffpLTCfpfacili
tiesfptofpadoptfpeffectivefpcompliance.
c.fpACAfpsectionfp6002fprequiresfpthefpestablishmentfpoffpafptransparencyfpprogram,fpnow
fpknownfpasfpCMSfpOpenfpPayments.
WhichfpstatementfpisfpTRUEfpregardingfpcompliancefpprograms?
a.fpCompliancefpprogramsfparefpconsideredfpmorefpdangerousfpiffptheyfparefpdevelopedfp
butfpnotfpimplemented.
b.fpCompliancefpprogramsfpcanfpdetectfpbutfpnotfppreventfpcriminalfpconduct
c.fpCompliancefpprogramsfparefponlyfprequiredfpbyfplawfpforfphealthcarefpentitiesfpthatfph
avefpmorefpthanfp$500,000fpinfpannualfprevenue.
d.fpCompliancefpprogramsfparefpnotfpmandatedfpbyfplaw.fp-
fpa.fpCompliancefpprogramsfparefpconsideredfpmorefpdangerousfpiffptheyfparefpdevelopedf
pbutfpnotfpimplemented.
Anfpindividual'sfpunderstandingfpoffpthefpcompliancefpaspectsfpoffptheirfpjobfpcanfpBESTfp
befpenhancedfpbyfpincludingfpcompliancefpin:
a.fpannualfpevaluations
TruefporfpFalse:
ThefpACAfprequiresfpthatfpallfpprovidersfpadoptfpafpcompliancefpplanfpasfpafpconditionfpo
ffpenrollmentfpwithfpMedicare,fpMedicaid,fpandfpChildren'sfpHealthfpInsurancefpProgramfp(
CHIP).fp-fpTrue
ref.fpACAfpsectionfp6102
AccordingfptofpHHS-OIGfp-
fpwhatfparefpthreefpimportantfpreasonsfpforfpproperfpdocumentationfpinfpCompliance?
fp(hint:fpprotections)fp-fp1.Protectfpourfpprograms
2.Protectfpyourfppatients
3.ProtectfpthefpProvider
https://oig.hhs.gov/newsroom/podcasts/2011/heat/heat09-trans.asp#:~:text=Proper
%20documentation%2C%20both%20in%20patients,to%20protect%20you%20the%20provider.
AtfpwhichfplevelfpoffpthefpMedicarefpPartfpAfporfpPartfpBfpappealsfpprocessfpisfpthefpapp
ealfpdecisionfpbyfpthefpOfficefpoffpMedicarefpHearingsfpandfpAppealsfp(OMHA)?
a.fpfirstfplevelfpoffpappeal
b.fpsecondfplevelfpoffpappeal
c.fpthirdfplevelfpoffpappeal
d.fpfourthfplevelfpoffpappealfp-fpc.fp.fpthirdfplevelfpoffpappeal
Fristfplevelfp-fpredeterminationfpbyfpMedicarefpcontractor
,Secondfplevelfp-fpreconsiderationfpbyfpIndependentfpcontractor
Thirdfpappealfp-fpAdministrativefpLawfpJudgefp(ALJ)fphearing
Fourthfpappealfp-fpreviewfpbyfpMedicarefpAppealsfpCouncil
Fifthfpappealfp-fpreviewfpinfpFederalfpDistrictfpCourt
https://www.hhs.gov/about/agencies/omha/the-appeals-process/index.html
WhatfpshouldfpCCOfpbefpablefptofpdo?
fp(Whatfpskillsfpshouldfpthisfppersonfphave?)fpChoosefpallfpthatfpapply.
a.fpLeadershipfpskills.
b.fpOverseefpthefpcodingfpdepartment.
c.fpSkillsfptofpdesignfpandfpimplementfpafpcompliancefpprogram.
d.fpBefpablefptofpanticipatefpnewfpriskfpareas.
e.fpPracticalfpexperiencefpwithfpdocumentingfpmedicalfpnecessity.fp-fpa.fpLeadershipfpskills,
c.fpSkillsfptofpdesignfpandfpimplementfpafpcompliancefpprogram,fpand
d.fpBefpablefptofpanticipatefpnewfpriskfpareas.
Whichfpoffpthefpfollowingfpisfpanfpabsolutefpnecessityfpinfporderfptofphavefpafpsuccessfulf
pCompliancefpProgram?
a.fpcontinuousfptrainingfpandfpimprovements
b.fpeffectivefpreportingfppath
c.fpnon-retaliationfpforfpwhistleblowers
d.fpreliablefpandfpequalfpdisciplinefp-fpc.fpnon-retaliationfpforfpwhistleblowers
AfpCompliancefpProgramfpwithfpwellfpwrittenfppoliciesfpandfpprocedures:
a.fpcanfpbefpsuccessfulfpiffpconsistentlyfpreviewedfpandfpmaintained
b.fpcannotfpbefpeffectivefpduefptofpthefpsheerfpvolumefppresented
c.fpwillfpbefpeffectivefpiffpreadfpbyfpmanagement
,d.fpwillfpnotfpbefpsuccessfulfpwithoutfpthefpproperfpoversightfp-
fpd.fpwillfpnotfpbefpsuccessfulfpwithoutfpthefpproperfpoversight
Regardlessfpoffphavingfpthefpbestfpwrittenfppoliciesfpinfpplacefpthatfparefpreviewed/
maintainedfpconsistently,fpandfpreadfpandfpdisseminatedfpaccordingly,fpwillfpfailfpiffptheref
pisfpnofpproperfpoversightfptofpensurefptheyfparefpactuallyfpbeingfpfollowedfpandfpunderst
ood.
AfpCompliancefpOfficerfpcanfpachievefpafphigherfplevelfpoffpcompliancefpandfpethicsfpenga
gementfpby:
a.fpensuringfpleadershipfpreadsfpthefppolicies
b.fpincreasingfpmanagementfpinvolvement
c.fprespondingfptofpcompliancefphotlinefpcalls
d.fpmonitoringfpthefpcodefpoffpconductfp-fpb.fpincreasingfpmanagementfpinvolvement.
Compliancefpisfpeveryone'sfpresponsibility,fpbutfpmanagementfpinvolvementfpisfpcrucial.fpT
heyfphavefpafpdirectfpcontactfpwithfpemployees,fptheyfpknowfpandfpunderstandfptheirfpsta
ff'sfpneedsfpandfpconcerns,fpandfphavefpthefpmostfpinfluencefpoverfpemployee'sfpactionsfp
andfpattitudes.fpEmployeesfpmostfplikelyfpusefptheirfpdirectfpmanager(s)fptofpraisefpconcer
nsfpandfpthefpreasonfptheyfparefpsofpcriticalfpforfpanfporganizationfptofpfosterfpafpculturef
poffpcompliance.
Whichfpoffpthefpfollowingfprequiresfpprovidersfptofpbefppermanentlyfpexcludedfpfromfpallf
pfederalfphealthfpcarefpprogramsfpiffpfoundfpguiltyfpoffpafphealthcarefprelatedfpfraudfpafpt
hirdfptime:
a.fpDeficitfpReductionfpActfpoffp2005
b.fpFalsefpClaimsfpAct
c.fpBalancefpBudgetfpActfpoffp1997
d.fpSocialfpSecurityfpActfpsectionfp1128dfp-fpc.fpBalancefpBudgetfpActfpoffp1997
, AlsofpknownfpasfpafpBBAfp"threefpstrikesfprule"
WhatfpsectionfpoffpthefpACAfppreventsfpdiscriminationfpagainstfpindividualsfpwithfplimitedf
pEnglishfpproficiencyfp(LEP),fpandfpalsofpprohibitsfpdiscriminationfpinfphealthcarefpprogram
sfpandfpactivitiesfpthatfpreceivefpfederalfpfunding,fpbasedfponfprace,fpcolor,fpnationalfporig
in,fpsex,fpage,fporfpdisability.
a.fpACAfpsectionfp6102
b.fpACAfpsectionfp1557
c.fpACAfpsectionfp6002fp-fpb.fpACAfpsectionfp1557fpisfpthefpcorrectfpanswer.
a.fpACAfpsectionfp6102fprequiresfpowners,fpoperators,fpandfpadministratorsfpoffpLTCfpfacili
tiesfptofpadoptfpeffectivefpcompliance.
c.fpACAfpsectionfp6002fprequiresfpthefpestablishmentfpoffpafptransparencyfpprogram,fpnow
fpknownfpasfpCMSfpOpenfpPayments.
WhichfpstatementfpisfpTRUEfpregardingfpcompliancefpprograms?
a.fpCompliancefpprogramsfparefpconsideredfpmorefpdangerousfpiffptheyfparefpdevelopedfp
butfpnotfpimplemented.
b.fpCompliancefpprogramsfpcanfpdetectfpbutfpnotfppreventfpcriminalfpconduct
c.fpCompliancefpprogramsfparefponlyfprequiredfpbyfplawfpforfphealthcarefpentitiesfpthatfph
avefpmorefpthanfp$500,000fpinfpannualfprevenue.
d.fpCompliancefpprogramsfparefpnotfpmandatedfpbyfplaw.fp-
fpa.fpCompliancefpprogramsfparefpconsideredfpmorefpdangerousfpiffptheyfparefpdevelopedf
pbutfpnotfpimplemented.
Anfpindividual'sfpunderstandingfpoffpthefpcompliancefpaspectsfpoffptheirfpjobfpcanfpBESTfp
befpenhancedfpbyfpincludingfpcompliancefpin:
a.fpannualfpevaluations
