HCCA CHC| REAL EXAM QUESTIONS AND VERIFIED AN-
SWERS|GRADED A+|PASS ON FIRST ATTEMPT|BRAND NEW
2026 UPDATE
HEALTHCARE COMPLIANCE
THESTUDY VAULT
,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 Com-
pliance? (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%20pro-
tect%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
1
,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 Pro-
gram?
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
2
, Regardless of having the best written policies in place that are reviewed/maintained consist-
ently, and read and disseminated accordingly, will fail if there is no proper oversight to en-
sure 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 organ-
ization 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 pro-
ficiency (LEP), and also prohibits discrimination in healthcare programs and activities that re-
ceive federal funding, based on race, color, national origin, sex, age, or disability.
a. ACA section 6102
3
SWERS|GRADED A+|PASS ON FIRST ATTEMPT|BRAND NEW
2026 UPDATE
HEALTHCARE COMPLIANCE
THESTUDY VAULT
,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 Com-
pliance? (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%20pro-
tect%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
1
,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 Pro-
gram?
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
2
, Regardless of having the best written policies in place that are reviewed/maintained consist-
ently, and read and disseminated accordingly, will fail if there is no proper oversight to en-
sure 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 organ-
ization 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 pro-
ficiency (LEP), and also prohibits discrimination in healthcare programs and activities that re-
ceive federal funding, based on race, color, national origin, sex, age, or disability.
a. ACA section 6102
3
