CHC Exam Prep |2023/ 2024 Update|
Questions and Verified Answers with
Rationales| 100% Correct
QUESTION
You are in charge of payment of claims submitted from providers. You notice a certain
diagnostic provider ("Doe Diagnostics") has requested a substantial payment for a large number
of members. Many of these claims are for a certain procedure. You review the same type of
procedure for other diagnostic providers and realize that Doe Diagnostics' claims far exceed any
other provider that you reviewed. What do you do?
A. Call Doe Diagnostics and request additional information for the claims
B. Consult with your immediate supervisor or Compliance Department for next steps
C. Reject the claims
D. Pay the claims
Answer:
B. Consult with your immediate supervisor for next steps or contact the compliance department
(via compliance hotline, Special Investigations Unit [SIU], or other mechanism)
You do not want to contact the provider. This may jeopardize an investigation. Nor do you want
to pay or reject the claims until further discussions with your supervisor or the compliance
department have occurred, including whether additional documentation is necessary.
QUESTION
You are performing a regular inventory of the controlled substances in the pharmacy. You
discover a minor inventory discrepancy. What should you do?
A. Call the local law enforcement
B. Perform another review
C. Contact your compliance department
D. Discuss your concerns with your supervisor
E. Follow your pharmacies procedures
Answer:
E. Follow your pharmacies procedures
Since this is a minor discrepancy in the inventory you are not required to notify the DEA. You
should follow your pharmacies procedures to determine the next steps.
,QUESTION
When a provider's Self-Disclosure is made in good faith and fully cooperates with the OIG's
review and resolution, incentives for disclosure may include:
a. reduced damages by 10%
b. lower settlement and no CIA
c. no civil monetary penalties, 100% forgiveness
d. none of the above
Answer:
b. lower settlement and no CIA
Payment of a lower settlement (or lower multiplier in single damages) and no CIA if the
organization has cooperated fully.
Ref: OIG's Provider SDP - section I.B: Benefits of Disclosure.
https://oig.hhs.gov/compliance/self-disclosure-info/files/Provider-Self-Disclosure-Protocol.pdf
QUESTION
The claims department needs to determine the initial baseline view of a particular billing practice
to represent the beginning of a review process. What type of audit should be conducted?
a. A probe audit
b. Retrospective Audit
c. A contemporaneous review
d. Retroactive audit
Answer:
c. A contemporaneous review
QUESTION
A compliance professional is conducting a policy review. Which of the following procedures
MUST be included in the policy for statistically valid sampling and extrapolation?
a. financial error rate exceeds 5% with a refund to occur within 60 days
b. financial error rate exceeds 5% with a refund to occur within 90 days
c. coding error rate exceeds 5% with a refund to occur within 60 days
d. coding error rate exceeds 5% with a refund to occur within 90 days
,Answer:
a. financial error rate exceeds 5% with a refund to occur within 60 days
QUESTION
The compliance professional is preparing a training session for the Board of Directors about the
Yates Memo. Which of the following does the Yates Memo emphasize?
a. Increased culpability score of organization
b. Individuals will be prosecuted before the organization will.
c. The Board is not responsible for bad decisions made by the organization
d. None of the above
Answer:
b. Individuals will be prosecuted before the organization will.
Yates Memo discusses individual accountability for corporate wrong doing.
https://www.justice.gov/archives/dag/individual-accountability
QUESTION
A provider is in the middle of a dispute. Legal Counsel writes two letters to this provider
analyzing certain aspects of the dispute. The information contained in the letter is considered
privileged. The provider accidentally hands these letters over to a third party not associated with
the practice. As a result of handing over these letters to the third party, the provider may have
caused the attorney-client privileged to be what?
a. Directly Waived
b. Inadvertently Waived
c. Subject to the Crime-Fraud Exception
d. Regulatory Waived
Answer:
b. Inadvertently Waived.
Explanation: Inadvertent waiver of the privilege may occur if appropriate steps are not taken to
maintain the confidentiality of the information gathered during the investigation. Courts use
three separate approaches to determine whether a disclosure results in an inadvertent waiver.
Ref. Chapter 4 of the Auditing and Monitoring book 2nd ed.
, QUESTION
A compliance professional conducts an investigation into allegations of physicians and nurses
taking pictures of injuries and posting them on a social network. It is confirmed that the two
physicians and a nurse have engaged in this behavior. Which of the following is the compliance
professional's and HR director's BEST action?
a. review and adhere to the organization's disciplinary policy
b. revoke the physician's hospital privileges, and terminate 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
QUESTION
A preliminary investigation identified payments to physicians for medical directorship without
written contracts. Which of the following should be the compliance professional's NEXT step?
a. determine if Medicare payments were received
b. initiate a voluntary disclosure
c. provide education to contracting office
d. refund payments to the contractors
Answer:
a. determine if Medicare payments were received
QUESTION
In an investigation, the MOST important responsibility of the compliance professional is to
a. personally conduct all investigations
b. assure independence in investigations
c. set the scope and sample size related to investigations
d. remain within the budget for investigations
Answer:
c. set the scope and sample size related to investigations
QUESTION
Questions and Verified Answers with
Rationales| 100% Correct
QUESTION
You are in charge of payment of claims submitted from providers. You notice a certain
diagnostic provider ("Doe Diagnostics") has requested a substantial payment for a large number
of members. Many of these claims are for a certain procedure. You review the same type of
procedure for other diagnostic providers and realize that Doe Diagnostics' claims far exceed any
other provider that you reviewed. What do you do?
A. Call Doe Diagnostics and request additional information for the claims
B. Consult with your immediate supervisor or Compliance Department for next steps
C. Reject the claims
D. Pay the claims
Answer:
B. Consult with your immediate supervisor for next steps or contact the compliance department
(via compliance hotline, Special Investigations Unit [SIU], or other mechanism)
You do not want to contact the provider. This may jeopardize an investigation. Nor do you want
to pay or reject the claims until further discussions with your supervisor or the compliance
department have occurred, including whether additional documentation is necessary.
QUESTION
You are performing a regular inventory of the controlled substances in the pharmacy. You
discover a minor inventory discrepancy. What should you do?
A. Call the local law enforcement
B. Perform another review
C. Contact your compliance department
D. Discuss your concerns with your supervisor
E. Follow your pharmacies procedures
Answer:
E. Follow your pharmacies procedures
Since this is a minor discrepancy in the inventory you are not required to notify the DEA. You
should follow your pharmacies procedures to determine the next steps.
,QUESTION
When a provider's Self-Disclosure is made in good faith and fully cooperates with the OIG's
review and resolution, incentives for disclosure may include:
a. reduced damages by 10%
b. lower settlement and no CIA
c. no civil monetary penalties, 100% forgiveness
d. none of the above
Answer:
b. lower settlement and no CIA
Payment of a lower settlement (or lower multiplier in single damages) and no CIA if the
organization has cooperated fully.
Ref: OIG's Provider SDP - section I.B: Benefits of Disclosure.
https://oig.hhs.gov/compliance/self-disclosure-info/files/Provider-Self-Disclosure-Protocol.pdf
QUESTION
The claims department needs to determine the initial baseline view of a particular billing practice
to represent the beginning of a review process. What type of audit should be conducted?
a. A probe audit
b. Retrospective Audit
c. A contemporaneous review
d. Retroactive audit
Answer:
c. A contemporaneous review
QUESTION
A compliance professional is conducting a policy review. Which of the following procedures
MUST be included in the policy for statistically valid sampling and extrapolation?
a. financial error rate exceeds 5% with a refund to occur within 60 days
b. financial error rate exceeds 5% with a refund to occur within 90 days
c. coding error rate exceeds 5% with a refund to occur within 60 days
d. coding error rate exceeds 5% with a refund to occur within 90 days
,Answer:
a. financial error rate exceeds 5% with a refund to occur within 60 days
QUESTION
The compliance professional is preparing a training session for the Board of Directors about the
Yates Memo. Which of the following does the Yates Memo emphasize?
a. Increased culpability score of organization
b. Individuals will be prosecuted before the organization will.
c. The Board is not responsible for bad decisions made by the organization
d. None of the above
Answer:
b. Individuals will be prosecuted before the organization will.
Yates Memo discusses individual accountability for corporate wrong doing.
https://www.justice.gov/archives/dag/individual-accountability
QUESTION
A provider is in the middle of a dispute. Legal Counsel writes two letters to this provider
analyzing certain aspects of the dispute. The information contained in the letter is considered
privileged. The provider accidentally hands these letters over to a third party not associated with
the practice. As a result of handing over these letters to the third party, the provider may have
caused the attorney-client privileged to be what?
a. Directly Waived
b. Inadvertently Waived
c. Subject to the Crime-Fraud Exception
d. Regulatory Waived
Answer:
b. Inadvertently Waived.
Explanation: Inadvertent waiver of the privilege may occur if appropriate steps are not taken to
maintain the confidentiality of the information gathered during the investigation. Courts use
three separate approaches to determine whether a disclosure results in an inadvertent waiver.
Ref. Chapter 4 of the Auditing and Monitoring book 2nd ed.
, QUESTION
A compliance professional conducts an investigation into allegations of physicians and nurses
taking pictures of injuries and posting them on a social network. It is confirmed that the two
physicians and a nurse have engaged in this behavior. Which of the following is the compliance
professional's and HR director's BEST action?
a. review and adhere to the organization's disciplinary policy
b. revoke the physician's hospital privileges, and terminate 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
QUESTION
A preliminary investigation identified payments to physicians for medical directorship without
written contracts. Which of the following should be the compliance professional's NEXT step?
a. determine if Medicare payments were received
b. initiate a voluntary disclosure
c. provide education to contracting office
d. refund payments to the contractors
Answer:
a. determine if Medicare payments were received
QUESTION
In an investigation, the MOST important responsibility of the compliance professional is to
a. personally conduct all investigations
b. assure independence in investigations
c. set the scope and sample size related to investigations
d. remain within the budget for investigations
Answer:
c. set the scope and sample size related to investigations
QUESTION
