CHC Auditing & Monitoring (1)
Questions and Answers 100% Correct
True or False:
Risk Management aligns with Quality Management in determining measures for risk avoidance
and prevention ✔✔TRUE
Your organization recently completed a contemporaneous audit of laboratory billing practices
and found that copays have been written off. Which of the following should be your next step?
a. Talk to the billing department to see why this is happening
b. Conduct a retrospective audit to see if this occurred in the past
c. Self-disclose this issue to limit the chance of a qui-tam suit
d. Fire the employee so the problem goes away ✔✔a. Talk to the billing department to see why
this is happening
The billing manager was conducting a contemporaneous review and found what could be a
significant error. The billing manager contacts you and you then subsequently contact your in-
house legal counsel. Which of the following statements are False?
a. Because of the False Claims Act, your in-house counsel advises you that the retrospective
audit will need to cover a minimum of 6 years to a maximum of 10 years.
,b. If you do not refund the Medicare overpayments, you could be charged with a federal felony
under the Social Security Act.
c. A contemporaneous review that was done by the billing manager would be covered under the
attorney-client privilege.
d. You are asked to perform a statistical sample of the population. You need to know that a larger
sample size will be required if the variation in the errors is larger. ✔✔c. A contemporaneous
review that was done by the billing manager would be covered under the attorney-client
privilege.
Explanation: A significant limitation of the definition of protected communications relates to
documents that are prepared by the client prior to the time when the attorney began preparations
to give advice.
Ref. Healthcare Compliance Professional's Manual
Who is responsible for enforcing rules and regulations under Medicare/Medicaid laws? ✔✔OIG
and Justice Department
A privacy professional is reviewing a program for an academic medical center that include a
faculty group practice, hospital, student health center, and self-funded group health plan. The
privacy professional should evaluate if the program has notices for:
,a. GINA
b. FMLA
c. HIPAA
d. FISMA ✔✔c. HIPAA
A health system implemented an EHR in 55 clinics. The privacy professional is told employees
are inconsistently interpreting the policy addressing employee access to EHR. Which of the
following is the privacy professional's BEST strategy?
a. Collaborate with HR to ensure appropriate discipline
b. Perform an audit under Attorney-Client Privilege
c. Conduct surveys of clinic employees concerns
d. Audit a random sampling of clinics across the organization ✔✔c. Conduct surveys of clinic
employees concerns
Who recommends an auditing and monitoring plan for an effective compliance program?
a. OIG Supplemental Guidance for Hospitals
b. CMS Conditions of Participation
c. Dept of Health and Human Svc
d. Internal Revenue Service ✔✔a. OIG Supplemental Guidance for Hospitals
, What is a benefit of a contemporaneous review?
a. Can provide a chance to do a self-disclosure of prior billing errors
b. Helps with creating a code of ethics
c. Can correct a problem before it grows to become a serious issue
d. Allows employees to submit anonymous reports of fraud ✔✔c. Can correct a problem before
it grows to become a serious issue.
You reviewed 30 inpatient claims and the error rate was higher than the threshold that had been
set, indicating possibility of a problem. To assess the seriousness of the problem, you would pull
what type of sample:
a. Probe
b. Discovery
c. Full statistical
d. Situational ✔✔b. Discovery
Remember: Probe (30 units) - Discovery (50 units) - Full Statistical (100% of universe)
Which of the following statements are true regarding Statute of Limitations (False Claims Act):
Questions and Answers 100% Correct
True or False:
Risk Management aligns with Quality Management in determining measures for risk avoidance
and prevention ✔✔TRUE
Your organization recently completed a contemporaneous audit of laboratory billing practices
and found that copays have been written off. Which of the following should be your next step?
a. Talk to the billing department to see why this is happening
b. Conduct a retrospective audit to see if this occurred in the past
c. Self-disclose this issue to limit the chance of a qui-tam suit
d. Fire the employee so the problem goes away ✔✔a. Talk to the billing department to see why
this is happening
The billing manager was conducting a contemporaneous review and found what could be a
significant error. The billing manager contacts you and you then subsequently contact your in-
house legal counsel. Which of the following statements are False?
a. Because of the False Claims Act, your in-house counsel advises you that the retrospective
audit will need to cover a minimum of 6 years to a maximum of 10 years.
,b. If you do not refund the Medicare overpayments, you could be charged with a federal felony
under the Social Security Act.
c. A contemporaneous review that was done by the billing manager would be covered under the
attorney-client privilege.
d. You are asked to perform a statistical sample of the population. You need to know that a larger
sample size will be required if the variation in the errors is larger. ✔✔c. A contemporaneous
review that was done by the billing manager would be covered under the attorney-client
privilege.
Explanation: A significant limitation of the definition of protected communications relates to
documents that are prepared by the client prior to the time when the attorney began preparations
to give advice.
Ref. Healthcare Compliance Professional's Manual
Who is responsible for enforcing rules and regulations under Medicare/Medicaid laws? ✔✔OIG
and Justice Department
A privacy professional is reviewing a program for an academic medical center that include a
faculty group practice, hospital, student health center, and self-funded group health plan. The
privacy professional should evaluate if the program has notices for:
,a. GINA
b. FMLA
c. HIPAA
d. FISMA ✔✔c. HIPAA
A health system implemented an EHR in 55 clinics. The privacy professional is told employees
are inconsistently interpreting the policy addressing employee access to EHR. Which of the
following is the privacy professional's BEST strategy?
a. Collaborate with HR to ensure appropriate discipline
b. Perform an audit under Attorney-Client Privilege
c. Conduct surveys of clinic employees concerns
d. Audit a random sampling of clinics across the organization ✔✔c. Conduct surveys of clinic
employees concerns
Who recommends an auditing and monitoring plan for an effective compliance program?
a. OIG Supplemental Guidance for Hospitals
b. CMS Conditions of Participation
c. Dept of Health and Human Svc
d. Internal Revenue Service ✔✔a. OIG Supplemental Guidance for Hospitals
, What is a benefit of a contemporaneous review?
a. Can provide a chance to do a self-disclosure of prior billing errors
b. Helps with creating a code of ethics
c. Can correct a problem before it grows to become a serious issue
d. Allows employees to submit anonymous reports of fraud ✔✔c. Can correct a problem before
it grows to become a serious issue.
You reviewed 30 inpatient claims and the error rate was higher than the threshold that had been
set, indicating possibility of a problem. To assess the seriousness of the problem, you would pull
what type of sample:
a. Probe
b. Discovery
c. Full statistical
d. Situational ✔✔b. Discovery
Remember: Probe (30 units) - Discovery (50 units) - Full Statistical (100% of universe)
Which of the following statements are true regarding Statute of Limitations (False Claims Act):
