HCCA - CHC STUDY QUESTIONS
(MASTER FLASHCARDS) EXAM
WITH CORRECT QUESTIONS AND
ANSWERS 2025
o True or False:
o 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-ANSWERSTrue
o ref. ACA section 6102
o According to HHS-OIG - what are three important reasons for proper documentation in
Compliance? (hint: protections) - CORRECT-ANSWERS1.Protect our programs
o 2.Protect your patients
o 3.Protect the Provider
o https://oig.hhs.gov/newsroom/podcasts/2011/heat/heat09-trans.asp#:~:text=Proper
%20documentation%2C%20both%20in%20patients,to%20protect%20you%20the
%20provider.
o 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)?
o first level of appeal
,o second level of appeal
o third level of appeal
o fourth level of appeal - CORRECT-ANSWERSc. . third level of appeal
o Frist level - redetermination by Medicare contractor
o Second level - reconsideration by Independent contractor
o Third appeal - Administrative Law Judge (ALJ) hearing
o Fourth appeal - review by Medicare Appeals Council
o Fifth appeal - review in Federal District Court
o https://www.hhs.gov/about/agencies/omha/the-appeals-process/index.html
o What should CCO be able to do? (What skills should this person have?) Choose all that
apply.
o Leadership skills.
o Oversee the coding department.
o Skills to design and implement a compliance program.
o Be able to anticipate new risk areas.
o Practical experience with documenting medical necessity. - CORRECT-ANSWERSa.
Leadership skills,
o c. Skills to design and implement a compliance program, and
o Be able to anticipate new risk areas.
o Which of the following is an absolute necessity in order to have a successful Compliance
Program?
,o continuous training and improvements
o effective reporting path
o non-retaliation for whistleblowers
o reliable and equal discipline - CORRECT-ANSWERSc. non-retaliation for
whistleblowers
o A Compliance Program with well written policies and procedures:
o can be successful if consistently reviewed and maintained
o cannot be effective due to the sheer volume presented
o will be effective if read by management
o will not be successful without the proper oversight - CORRECT-ANSWERSd. will not
be successful without the proper oversight
o 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.
o A Compliance Officer can achieve a higher level of compliance and ethics engagement
by:
o ensuring leadership reads the policies
o increasing management involvement
o responding to compliance hotline calls
o monitoring the code of conduct - CORRECT-ANSWERSb. increasing management
involvement.
, o 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.
o 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:
o Deficit Reduction Act of 2005
o False Claims Act
o Balance Budget Act of 1997
o Social Security Act section 1128d - CORRECT-ANSWERSc. Balance Budget Act of
1997
o Also known as a BBA "three strikes rule"
o 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.
o ACA section 6102
o ACA section 1557
o ACA section 6002 - CORRECT-ANSWERSb. ACA section 1557 is the correct answer.
(MASTER FLASHCARDS) EXAM
WITH CORRECT QUESTIONS AND
ANSWERS 2025
o True or False:
o 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-ANSWERSTrue
o ref. ACA section 6102
o According to HHS-OIG - what are three important reasons for proper documentation in
Compliance? (hint: protections) - CORRECT-ANSWERS1.Protect our programs
o 2.Protect your patients
o 3.Protect the Provider
o https://oig.hhs.gov/newsroom/podcasts/2011/heat/heat09-trans.asp#:~:text=Proper
%20documentation%2C%20both%20in%20patients,to%20protect%20you%20the
%20provider.
o 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)?
o first level of appeal
,o second level of appeal
o third level of appeal
o fourth level of appeal - CORRECT-ANSWERSc. . third level of appeal
o Frist level - redetermination by Medicare contractor
o Second level - reconsideration by Independent contractor
o Third appeal - Administrative Law Judge (ALJ) hearing
o Fourth appeal - review by Medicare Appeals Council
o Fifth appeal - review in Federal District Court
o https://www.hhs.gov/about/agencies/omha/the-appeals-process/index.html
o What should CCO be able to do? (What skills should this person have?) Choose all that
apply.
o Leadership skills.
o Oversee the coding department.
o Skills to design and implement a compliance program.
o Be able to anticipate new risk areas.
o Practical experience with documenting medical necessity. - CORRECT-ANSWERSa.
Leadership skills,
o c. Skills to design and implement a compliance program, and
o Be able to anticipate new risk areas.
o Which of the following is an absolute necessity in order to have a successful Compliance
Program?
,o continuous training and improvements
o effective reporting path
o non-retaliation for whistleblowers
o reliable and equal discipline - CORRECT-ANSWERSc. non-retaliation for
whistleblowers
o A Compliance Program with well written policies and procedures:
o can be successful if consistently reviewed and maintained
o cannot be effective due to the sheer volume presented
o will be effective if read by management
o will not be successful without the proper oversight - CORRECT-ANSWERSd. will not
be successful without the proper oversight
o 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.
o A Compliance Officer can achieve a higher level of compliance and ethics engagement
by:
o ensuring leadership reads the policies
o increasing management involvement
o responding to compliance hotline calls
o monitoring the code of conduct - CORRECT-ANSWERSb. increasing management
involvement.
, o 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.
o 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:
o Deficit Reduction Act of 2005
o False Claims Act
o Balance Budget Act of 1997
o Social Security Act section 1128d - CORRECT-ANSWERSc. Balance Budget Act of
1997
o Also known as a BBA "three strikes rule"
o 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.
o ACA section 6102
o ACA section 1557
o ACA section 6002 - CORRECT-ANSWERSb. ACA section 1557 is the correct answer.
