HCCA - CHC Study All Questions (MASTER FLASHCARDS) With
Complete Solutions Latest Update 100% pass
True or False:
ACA requires that all providers adopt a compliance plan as a condition of enrollment
with Medicare, Medicaid, and 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%20
documentation%2C%20both%20in%20patients,to%20protect%20you%20the%20provide
r.
What level in the Medicare Part A or Part B appeals process is assigned to an appeal
decision made by the Office of Medicare Hearings and Appeals?
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 -redetermination by Medicare contractor
Second - 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 this person should possess?) Select all that
apply.
a. Leadership skills.
b. Manage the coding department.
c. Abilities to develop and implement a compliance program.
d. Be able to predict new risk areas.
e. Have field experience with medical necessity documentation. - ANSWER a.
Leadership skills,
c. Abilities to design and implement a compliance program, and
d. Can predict new areas of risk.
Which of the following is absolutely necessary to have a successful Compliance
Program?
a. ongoing training and enhancements
b. effective reporting path
c. non-retaliation for whistleblowers
d. adequate and fair discipline - ANSWER c. non-retaliation for whistleblowers
A Compliance Program with well written policies and procedures:
a. can be successful if kept current and on-going
b. cannot be effective due to the shear 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
,A Compliance Officer can attain a larger level of compliance and ethics involvement by:
a. getting the leadership to read the policies
b. obtaining management to increase involvement
c. returning compliance hotline calls
d. monitoring the code of conduct - ANSWER b. increasing management involvement
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 1128 - ANSWER c. Balance Budget Act of 1997
Also known as a BBA "three strikes rule"
Which of the following statements is TRUE about compliance programs?
a. Compliance programs are considered more dangerous if they are developed but not
adhered to.
b. Compliance programs can detect but cannot deter criminal activity
c. Compliance programs are only legally required for health care organizations that
have more than $500,000 in annual revenue.
d. Compliance programs are not required by law. - ANSWER a. Compliance programs
are considered more harmful if they are written but not followed.
Formal statement providing a course of action for a defined subject area. It typically
references state and/or federal required actions or standards.
a. CAP
b. Procedure document
c. Policy document
d. Legal standards - ANSWER c. Policy document
, CAP - provides corrective action plan
Procedure - process/steps for a given circumstance
Legal standards - what a person must do or not do
Life cycle of records management Creation
Use
Maintenance
Retention
Disposition
Standards of Conduct (written P&Ps) ANSWER Reflect the organization's ethical
attitude and its "enterprise-wide" emphasis on compliance with all applicable laws and
regulations
Code of Conduct: Content Checklist ANSWER • Show system wide emphasis on
compliance with all applicable laws and regulations
• In writing and written in plain simple language so that all employees will understand
the standards
• Internal and external regulations
• Organization-wide policies are referenced but not fully reiterated
• Consistent with organization policies and procedures
• Management is responsible for explaining and implementing the code
Ref: SCCE Compliance & Ethics Manual, Chapter 2
https://compliancecosmos.org/essential-elements-effective-ethics-and-compliance-prog
ram
Code of Conduct and Employees - QUESTION All employees should be issued a copy of,
read and understand the standards.
Complete Solutions Latest Update 100% pass
True or False:
ACA requires that all providers adopt a compliance plan as a condition of enrollment
with Medicare, Medicaid, and 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%20
documentation%2C%20both%20in%20patients,to%20protect%20you%20the%20provide
r.
What level in the Medicare Part A or Part B appeals process is assigned to an appeal
decision made by the Office of Medicare Hearings and Appeals?
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 -redetermination by Medicare contractor
Second - 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 this person should possess?) Select all that
apply.
a. Leadership skills.
b. Manage the coding department.
c. Abilities to develop and implement a compliance program.
d. Be able to predict new risk areas.
e. Have field experience with medical necessity documentation. - ANSWER a.
Leadership skills,
c. Abilities to design and implement a compliance program, and
d. Can predict new areas of risk.
Which of the following is absolutely necessary to have a successful Compliance
Program?
a. ongoing training and enhancements
b. effective reporting path
c. non-retaliation for whistleblowers
d. adequate and fair discipline - ANSWER c. non-retaliation for whistleblowers
A Compliance Program with well written policies and procedures:
a. can be successful if kept current and on-going
b. cannot be effective due to the shear 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
,A Compliance Officer can attain a larger level of compliance and ethics involvement by:
a. getting the leadership to read the policies
b. obtaining management to increase involvement
c. returning compliance hotline calls
d. monitoring the code of conduct - ANSWER b. increasing management involvement
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 1128 - ANSWER c. Balance Budget Act of 1997
Also known as a BBA "three strikes rule"
Which of the following statements is TRUE about compliance programs?
a. Compliance programs are considered more dangerous if they are developed but not
adhered to.
b. Compliance programs can detect but cannot deter criminal activity
c. Compliance programs are only legally required for health care organizations that
have more than $500,000 in annual revenue.
d. Compliance programs are not required by law. - ANSWER a. Compliance programs
are considered more harmful if they are written but not followed.
Formal statement providing a course of action for a defined subject area. It typically
references state and/or federal required actions or standards.
a. CAP
b. Procedure document
c. Policy document
d. Legal standards - ANSWER c. Policy document
, CAP - provides corrective action plan
Procedure - process/steps for a given circumstance
Legal standards - what a person must do or not do
Life cycle of records management Creation
Use
Maintenance
Retention
Disposition
Standards of Conduct (written P&Ps) ANSWER Reflect the organization's ethical
attitude and its "enterprise-wide" emphasis on compliance with all applicable laws and
regulations
Code of Conduct: Content Checklist ANSWER • Show system wide emphasis on
compliance with all applicable laws and regulations
• In writing and written in plain simple language so that all employees will understand
the standards
• Internal and external regulations
• Organization-wide policies are referenced but not fully reiterated
• Consistent with organization policies and procedures
• Management is responsible for explaining and implementing the code
Ref: SCCE Compliance & Ethics Manual, Chapter 2
https://compliancecosmos.org/essential-elements-effective-ethics-and-compliance-prog
ram
Code of Conduct and Employees - QUESTION All employees should be issued a copy of,
read and understand the standards.
