HCCA–CHC Exam 2025-2026 – Practice Exam and Study
Guide with Verified Correct Answers and Explanations (A+
Graded)
Introduction:
This comprehensive study guide provides the newest and most
accurate preparation material for the Health Care Compliance
Association (HCCA) Certified in Healthcare Compliance (CHC)
exam. It includes verified questions with detailed, correct answers
and clear explanations covering all major compliance topics—such as
OIG and DOJ guidance, compliance program elements, fraud and
abuse laws, HIPAA privacy, auditing and monitoring, and corporate
integrity agreements. The guide is fully updated for 2025 and
organized to help candidates master exam-relevant concepts with
real exam-style questions and rationales.
Exam Questions and Answers
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). --- correct answer ---True
ref. ACA section 6102
According to HHS-OIG - what are three important reasons for
proper documentation in Compliance? (hint: protections) --- correct
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%20protect%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 --- correct answer ---c. . third level of
appeal
Frist level - redetermination by Medicare contractor
Second level - 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 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. ---
correct 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 Program?
a. continuous training and improvements
b. effective reporting path
c. non-retaliation for whistleblowers
d. reliable and equal discipline --- correct 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 --- correct
answer ---d. will not be successful without the proper oversight
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.
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 --- correct 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 organization to foster a
culture of compliance.
Guide with Verified Correct Answers and Explanations (A+
Graded)
Introduction:
This comprehensive study guide provides the newest and most
accurate preparation material for the Health Care Compliance
Association (HCCA) Certified in Healthcare Compliance (CHC)
exam. It includes verified questions with detailed, correct answers
and clear explanations covering all major compliance topics—such as
OIG and DOJ guidance, compliance program elements, fraud and
abuse laws, HIPAA privacy, auditing and monitoring, and corporate
integrity agreements. The guide is fully updated for 2025 and
organized to help candidates master exam-relevant concepts with
real exam-style questions and rationales.
Exam Questions and Answers
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). --- correct answer ---True
ref. ACA section 6102
According to HHS-OIG - what are three important reasons for
proper documentation in Compliance? (hint: protections) --- correct
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%20protect%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 --- correct answer ---c. . third level of
appeal
Frist level - redetermination by Medicare contractor
Second level - 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 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. ---
correct 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 Program?
a. continuous training and improvements
b. effective reporting path
c. non-retaliation for whistleblowers
d. reliable and equal discipline --- correct 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 --- correct
answer ---d. will not be successful without the proper oversight
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.
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 --- correct 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 organization to foster a
culture of compliance.
