HCCA - CHC EXAM STUDY PACK – WITH ACTUAL EXAM QUESTIONS AND 100% VERIFIED SOLUTIONS| LATEST UPDATED 2026

HCCA - CHC EXAM STUDY PACK – WITH ACTUAL EXAM QUESTIONS AND 100% VERIFIED SOLUTIONS| LATEST UPDATED 2026 _______ means the provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to a patient; or the referral of a patient for health care from one health care provider to another - answer-Treatment "...it cannot be emphasized enough that the only thing worse than not having a policy is having a policy and not following it." This statement refers to which of the Compliance Program Elements" - answerElement 1: Standards, Policies and Procedures (a Code of Conduct). Ref: SCCE Compliance & Ethics Program Manual, Chapter 2 "Auditing and Monitoring have distinct differences. Explain - answer-Auditing - formalized, independent, objective process Monitoring - informal process, day-to-day reviews, part of doing business, collaborative "He who brings the action for the king as well as for himself" - answer-Qui tam pro domino rege quam pro se ipso in hac parte sequitur 1984 Sentencing Reform Act - answer-Designed to correct inequities in deferral sentences. Includes the Federal Sentencing Guidelines that include guidance for assessing fines and detailed method for calculation of a "culpability score."2004 - Federal Sentencing Commission released "Ch 8 Part B - Remedying Harm from Criminal Conduct, and Effective Compliance and Ethics Program" - answer-These revisions focused on effective compliance and ethics programs. 5 most important federal fraud and abuse laws - answer-FCA, AKS, Stark Law, CMPL, and Exclusion Authorities A billing manager is reviewing the monthly reimbursement report for the department. The manager notices that there is an increase of 50% over the expected amount of incoming payments from Federal health care programs for treatment of patients. The manager believes action is needed. The manager's NEXT step is to: 1. Stop all outgoing claims to Federal health care programs 2. Extrapolate the last 6 months of reimbursement totals to identify the overpayment due to health care programs 3. Contact legal for next steps or further direction to include advice on how to proceed with the self disclosure protocol 4. Analyze the details related to the increase in payments to identify possible sources or causes for increase in reimbursement - answer-4. Analyze the details related to the increase in payments to identify possible sources or causes for increase in reimbursement A breach is considered discovered when a. The moment a workforce member commits a breach b. When another person on the workforce is aware of the breach c. When the workforce member who committed the breach reports it to the Privacy Officer d. When the breach is reported to the Office for Civil Rights - answer-b. When another person on the workforce is aware of the breach (When another person on the workforce is aware of the breach, that is when the breach is considered discovered) A CIA (Corporate Integrity Agreement) can be imposed instead of exclusions. How long are CIA's typically? a. 8 yearsb. 2 years c. 5 years - answer-c. 5 years generally (CIAs can range from 3-8 years) A clinic has patient data that an independent researcher would like to access. The researcher only needs de-identified information, but the clinic does not have the resources to strip the patients identifiers from the data being requested. The researcher does have the resources and offers to remove the identifiers before beginning the research. A privacy official should inform that it can provide the PHI to the researcher if the clinic: a. notifies each patient whose information is disclosed b. modifies the hospital's NPP c. requires the researcher to obtain waiver of authorization d. has the researcher shoe proof of privacy training - answer-c. requires the researcher to obtain waiver of authorization A co-worker is called away for a short errand and leaves the clinic PC logged onto the confidential information system. You need to look up information using a computer. Aside from notifying the appropriate person, what is the best approach you should take? a. To save time, just continue working under your co-worker's User-ID. b. Log you co-worker off and re-login under your own User-ID and password. c. Do nothing. d. All of the answers. - answer-b. Log you co-worker off and re-login under your own User-ID and password. A common reporting system, administered in house or by outside consultants, giving anonymous telephone access to employees seeking to report possible instances of wrongdoing - answer-Hotline or Helpline 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. A compliance professional conducts an investigation into allegations of physicians and nurses taking pictures of injuries and posting them in social media. The allegation is confirmed. Which of the following if the compliance professional's and HR director/administrator 's BEST action? a. review and adhere to the organization's disciplinary policy b. Revoke the physician's hospital privileges, and terminate the nurse. c. Report the incident to the PEER Review committee and the Nursing Board. d. Notify the Board of Directors, and act according to their recommendations. - answer-a. review and adhere to the organization's disciplinary policy (to ensure fair, equitable, and consistent disciplinary actions) A compliance professional discovers non-compliance with a regulation. Which of the following should the compliance professional do FIRST? a. Implement disciplinary actions b. Conduct a baseline audit c. Include it in the annual work plan d. Develop a risk specific education plan - answer-b. Conduct a baseline audit The baseline audit will give the compliance professional additional information needed to understand the issue, the root cause, if there is a need for additional training, audits, and/or any disciplinary action. A compliance professional has been working with a department director to implement a new policy regarding timely completion of medical records. Which of the following should be completed by the department manager to promote compliance with the new policy? a. Statistically valid sampling audit b. Monitoring c. Discovery Audit d. Retrospective Audit - answer-b. Monitoring