HCA Certification Training Exam 2026
Questions and Answers
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). - Correct answer-True
According to HHS-OIG - what are three important reasons for proper
documentation in Compliance?
1.Protect our ___________________
2.Protect your ___________________
3.Protect the ___________________ - Correct answer-1.Protect our programs
2.Protect your patients
3.Protect the Provider
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,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 - Correct answer-c. third level of appeal
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. - Correct answer-a.
Leadership skills, c. Skills to design and implement a compliance program, and d.
Be able to anticipate new risk areas.
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,What is the appeals process is the appeal decision by the Office of Medicare
Hearings and Appeals (OMHA)?
Frist level - _________________________
Second level - _________________________
Third appeal - _________________________
Fourth appeal - _________________________
Fifth appeal - _________________________ - Correct answer-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
Which of the following is an absolute necessity in order to have a successful
Compliance Program?
a. continuous training and improvements
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, b. effective reporting path
c. non-retaliation for whistleblowers
d. reliable and equal discipline - Correct answer-c. non-retaliation for
whistleblowers
A Compliance Program with well written policies and procedures:
a. can be successful if consistently reviewed and maintained
b. cannot be effective due to the sheer volume presented
c. will be effective if read by management
d. will not be successful without the proper oversight - Correct answer-d. will not
be successful without the proper oversight
A Compliance Officer can achieve a higher level of compliance and ethics
engagement by:
a. ensuring leadership reads the policies
b. increasing management involvement
c. responding to compliance hotline calls
d. monitoring the code of conduct - Correct answer-b. increasing management
involvement
©COPYRIGHT 2025, ALL RIGHTS RESERVED 4
Questions and Answers
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). - Correct answer-True
According to HHS-OIG - what are three important reasons for proper
documentation in Compliance?
1.Protect our ___________________
2.Protect your ___________________
3.Protect the ___________________ - Correct answer-1.Protect our programs
2.Protect your patients
3.Protect the Provider
©COPYRIGHT 2025, ALL RIGHTS RESERVED 1
,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 - Correct answer-c. third level of appeal
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. - Correct answer-a.
Leadership skills, c. Skills to design and implement a compliance program, and d.
Be able to anticipate new risk areas.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
,What is the appeals process is the appeal decision by the Office of Medicare
Hearings and Appeals (OMHA)?
Frist level - _________________________
Second level - _________________________
Third appeal - _________________________
Fourth appeal - _________________________
Fifth appeal - _________________________ - Correct answer-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
Which of the following is an absolute necessity in order to have a successful
Compliance Program?
a. continuous training and improvements
©COPYRIGHT 2025, ALL RIGHTS RESERVED 3
, b. effective reporting path
c. non-retaliation for whistleblowers
d. reliable and equal discipline - Correct answer-c. non-retaliation for
whistleblowers
A Compliance Program with well written policies and procedures:
a. can be successful if consistently reviewed and maintained
b. cannot be effective due to the sheer volume presented
c. will be effective if read by management
d. will not be successful without the proper oversight - Correct answer-d. will not
be successful without the proper oversight
A Compliance Officer can achieve a higher level of compliance and ethics
engagement by:
a. ensuring leadership reads the policies
b. increasing management involvement
c. responding to compliance hotline calls
d. monitoring the code of conduct - Correct answer-b. increasing management
involvement
©COPYRIGHT 2025, ALL RIGHTS RESERVED 4
