CHC Exam
Policy - Answers-A written document or statement reflecting standards or rules that regulate or guide
organizational action and employee conduct.
Procedure - Answers-The process followed to comply with a policy.
Work Instructions - Answers-Step-by-steps instructions, including information and equipment needed to
complete a specific task.
Approver - Answers-The person or department whose approval is required to implement the policy.
Policy Owner - Answers-The individual or department responsible for the content and administration of
the policy.
Subject Matter Expert - Answers-A person who has a deep understanding of the topic and process.
Code of Conduct - Answers-An industry standard for an organization to have a code of conduct that sets
forth the organization's commitment to comply with applicable federal and state laws, including laws
related to fraud and abuse.
Code of Conduct: Content Checklist - Answers-Letter from the CEO (or top executive)
Organization's values
Definition of the code, including its purpose and objectives
, Questions and answers and/or scenario-based examples of relevant situations
Details on reporting misconduct
Non-retaliation promise
Other resources (such as policies, resources, etc.)
Seven elements of an effective compliance program - Answers-1. implementing written policies,
procedures, and standards of conduct.
2. Designating a compliance officer and compliance committee.
3. Conducting effective training and education.
4. Developing effective lines of communication.
5. Conducting internal monitoring and auditing.
6. Enforcing standards through well-publicized disciplinary guidelines.
7. Responding promptly to detected offenses and undertaking corrective action.
Responsible Corporate Officer Doctrine - Answers-Applies to persons holding a position of responsibility
and authority in an organization and who possess the ability to prevent or correct a violation of law. A
corporate official can be held personally liable for corporate violations.
The US Federal Sentencing Guidelines - Answers-Guidelines set forth for prosecutors to consider when
determining the appropriate form of resolution or prosecution, monetary penalty, and potential
compliance obligations under a corporate criminal resolution.
Exclusions - Answers-The HHS OIG can exclude organizations found to have committed healthcare fraud
and abuse from participating in federally funded healthcare programs.
National Committee for Quality Assurance (NCQA) - Answers-Accredits health plans for participation in
Medicare Advantage and state Medicaid managed care programs, managed behavioral healthcare
organizations, credentials-verification organizations, and physician organizations.
Policy - Answers-A written document or statement reflecting standards or rules that regulate or guide
organizational action and employee conduct.
Procedure - Answers-The process followed to comply with a policy.
Work Instructions - Answers-Step-by-steps instructions, including information and equipment needed to
complete a specific task.
Approver - Answers-The person or department whose approval is required to implement the policy.
Policy Owner - Answers-The individual or department responsible for the content and administration of
the policy.
Subject Matter Expert - Answers-A person who has a deep understanding of the topic and process.
Code of Conduct - Answers-An industry standard for an organization to have a code of conduct that sets
forth the organization's commitment to comply with applicable federal and state laws, including laws
related to fraud and abuse.
Code of Conduct: Content Checklist - Answers-Letter from the CEO (or top executive)
Organization's values
Definition of the code, including its purpose and objectives
, Questions and answers and/or scenario-based examples of relevant situations
Details on reporting misconduct
Non-retaliation promise
Other resources (such as policies, resources, etc.)
Seven elements of an effective compliance program - Answers-1. implementing written policies,
procedures, and standards of conduct.
2. Designating a compliance officer and compliance committee.
3. Conducting effective training and education.
4. Developing effective lines of communication.
5. Conducting internal monitoring and auditing.
6. Enforcing standards through well-publicized disciplinary guidelines.
7. Responding promptly to detected offenses and undertaking corrective action.
Responsible Corporate Officer Doctrine - Answers-Applies to persons holding a position of responsibility
and authority in an organization and who possess the ability to prevent or correct a violation of law. A
corporate official can be held personally liable for corporate violations.
The US Federal Sentencing Guidelines - Answers-Guidelines set forth for prosecutors to consider when
determining the appropriate form of resolution or prosecution, monetary penalty, and potential
compliance obligations under a corporate criminal resolution.
Exclusions - Answers-The HHS OIG can exclude organizations found to have committed healthcare fraud
and abuse from participating in federally funded healthcare programs.
National Committee for Quality Assurance (NCQA) - Answers-Accredits health plans for participation in
Medicare Advantage and state Medicaid managed care programs, managed behavioral healthcare
organizations, credentials-verification organizations, and physician organizations.
