HCCA - CHC STUDY QUESTIONS (MASTER FLASHCARDS)
| 781 QUESTIONS AND ANSWERS | 2026 UPDATE WITH
COMPLETE SOLUTION
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). Answer - True
ref. ACA section 6102
According to HHS-OIG - what are three important reasons for proper
documentation in Compliance? (hint: protections) Answer - 1.Protect our
programs
2.Protect your patients
3.Protect the Provider
https://oig.hhs.gov/newsroom/podcasts/2011/heat/heat09-
trans.asp#:~:text=Proper%20documentation%2C%20both%20in%20patients,to
%20protect%20you%20the%20provider.
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 Answer - 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. Answer - a.
Leadership skills,
c. Skills to design and implement a compliance program, and
d. Be able to anticipate new risk areas.
Which of the following is an absolute necessity in order to have a successful
Compliance Program?
a. continuous training and improvements
b. effective reporting path
c. non-retaliation for whistleblowers
d. reliable and equal discipline 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 Answer - d. will not be
successful without the proper oversight
Regardless of having the best written policies in place that are
reviewed/maintained consistently, and read and disseminated accordingly, will
fail if there is no proper oversight to ensure they are actually being followed
and understood.
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 Answer - b. increasing management
involvement.
Compliance is everyone's responsibility, but management involvement is
crucial. They have a direct contact with employees, they know and understand
their staff's needs and concerns, and have the most influence over employee's
actions and attitudes. Employees most likely use their direct manager(s) to
raise concerns and the reason they are so critical for an organization to foster a
culture of compliance.
Which of the following requires providers to be permanently excluded from all
federal health care programs if found guilty of a healthcare related fraud a third
time:
, a. Deficit Reduction Act of 2005
b. False Claims Act
c. Balance Budget Act of 1997
d. Social Security Act section 1128d Answer - c. Balance Budget Act of 1997
Also known as a BBA "three strikes rule"
What section of the ACA prevents discrimination against individuals with
limited English proficiency (LEP), and also prohibits discrimination in healthcare
programs and activities that receive federal funding, based on race, color,
national origin, sex, age, or disability.
a. ACA section 6102
b. ACA section 1557
c. ACA section 6002 Answer - b. ACA section 1557 is the correct answer.
a. ACA section 6102 requires owners, operators, and administrators of LTC
facilities to adopt effective compliance.
c. ACA section 6002 requires the establishment of a transparency program,
now known as CMS Open Payments.
Which statement is TRUE regarding compliance programs?
a. Compliance programs are considered more dangerous if they are developed
but not implemented.
b. Compliance programs can detect but not prevent criminal conduct
c. Compliance programs are only required by law for healthcare entities that
have more than $500,000 in annual revenue.
| 781 QUESTIONS AND ANSWERS | 2026 UPDATE WITH
COMPLETE SOLUTION
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). Answer - True
ref. ACA section 6102
According to HHS-OIG - what are three important reasons for proper
documentation in Compliance? (hint: protections) Answer - 1.Protect our
programs
2.Protect your patients
3.Protect the Provider
https://oig.hhs.gov/newsroom/podcasts/2011/heat/heat09-
trans.asp#:~:text=Proper%20documentation%2C%20both%20in%20patients,to
%20protect%20you%20the%20provider.
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 Answer - 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. Answer - a.
Leadership skills,
c. Skills to design and implement a compliance program, and
d. Be able to anticipate new risk areas.
Which of the following is an absolute necessity in order to have a successful
Compliance Program?
a. continuous training and improvements
b. effective reporting path
c. non-retaliation for whistleblowers
d. reliable and equal discipline 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 Answer - d. will not be
successful without the proper oversight
Regardless of having the best written policies in place that are
reviewed/maintained consistently, and read and disseminated accordingly, will
fail if there is no proper oversight to ensure they are actually being followed
and understood.
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 Answer - b. increasing management
involvement.
Compliance is everyone's responsibility, but management involvement is
crucial. They have a direct contact with employees, they know and understand
their staff's needs and concerns, and have the most influence over employee's
actions and attitudes. Employees most likely use their direct manager(s) to
raise concerns and the reason they are so critical for an organization to foster a
culture of compliance.
Which of the following requires providers to be permanently excluded from all
federal health care programs if found guilty of a healthcare related fraud a third
time:
, a. Deficit Reduction Act of 2005
b. False Claims Act
c. Balance Budget Act of 1997
d. Social Security Act section 1128d Answer - c. Balance Budget Act of 1997
Also known as a BBA "three strikes rule"
What section of the ACA prevents discrimination against individuals with
limited English proficiency (LEP), and also prohibits discrimination in healthcare
programs and activities that receive federal funding, based on race, color,
national origin, sex, age, or disability.
a. ACA section 6102
b. ACA section 1557
c. ACA section 6002 Answer - b. ACA section 1557 is the correct answer.
a. ACA section 6102 requires owners, operators, and administrators of LTC
facilities to adopt effective compliance.
c. ACA section 6002 requires the establishment of a transparency program,
now known as CMS Open Payments.
Which statement is TRUE regarding compliance programs?
a. Compliance programs are considered more dangerous if they are developed
but not implemented.
b. Compliance programs can detect but not prevent criminal conduct
c. Compliance programs are only required by law for healthcare entities that
have more than $500,000 in annual revenue.
