5/22/26, 7:06 PM HCCA - CHC Study Questions (MASTER FLASHCARDS) Flashcards | Quizlet
HCCA - CHC Study Questions Save Groups
(MASTER FLASHCARDS)
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True or False: True
The ACA requires that all providers adopt a compliance
plan as a condition of enrollment with Medicare, ref. ACA section 6102
Medicaid, and Children's Health Insurance Program
(CHIP).
According to HHS-OIG - what are three important 1.Protect our programs
reasons for proper documentation in Compliance? (hint: 2.Protect your patients
protections) 3.Protect the Provider
https://oig.hhs.gov/newsroom/podcasts/2011/heat/heat09-
trans.asp#:~:text=Proper%20documentation%2C%20both%20in%20patients,to%20
protect%20you%20the%20provider.
At which level of the Medicare Part A or Part B appeals c. . third level of appeal
process is the appeal decision by the Office of Medicare
Hearings and Appeals (OMHA)? Frist level - redetermination by Medicare contractor
a. first level of appeal Second level - reconsideration by Independent contractor
b. second level of appeal Third appeal - Administrative Law Judge (ALJ) hearing
c. third level of appeal Fourth appeal - review by Medicare Appeals Council
d. fourth level of appeal 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 a. Leadership skills,
person have?) Choose all that apply. c. Skills to design and implement a compliance program, and
a. Leadership skills. d. Be able to anticipate new risk areas.
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.
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,5/22/26, 7:06 PM HCCA - CHC Study Questions (MASTER FLASHCARDS) Flashcards | Quizlet
Which of the following is an absolute necessity in order c. non-retaliation for whistleblowers
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
A Compliance Program with well written policies and d. will not be successful without the proper oversight
procedures:
a. can be successful if consistently reviewed and Regardless of having the best written policies in place that are
maintained reviewed/maintained consistently, and read and disseminated accordingly, will fail
b. cannot be effective due to the sheer volume presented if there is no proper oversight to ensure they are actually being followed and
c. will be effective if read by management understood.
d. will not be successful without the proper oversight
A Compliance Officer can achieve a higher level of b. increasing management involvement.
compliance and ethics engagement by:
a. ensuring leadership reads the policies Compliance is everyone's responsibility, but management involvement is crucial.
b. increasing management involvement They have a direct contact with employees, they know and understand their staff's
c. responding to compliance hotline calls needs and concerns, and have the most influence over employee's actions and
d. monitoring the code of conduct 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.
Which of the following requires providers to be c. Balance Budget Act of 1997
permanently excluded from all federal health care
programs if found guilty of a healthcare related fraud a Also known as a BBA "three strikes rule"
third time:
a. Deficit Reduction Act of 2005
b. False Claims Act
c. Balance Budget Act of 1997
d. Social Security Act section 1128d
What section of the ACA prevents discrimination against b. ACA section 1557 is the correct answer.
individuals with limited English proficiency (LEP), and also
prohibits discrimination in healthcare programs and
activities that receive federal funding, based on race, a. ACA section 6102 requires owners, operators, and administrators of LTC facilities
color, national origin, sex, age, or disability. to adopt effective compliance.
a. ACA section 6102 c. ACA section 6002 requires the establishment of a transparency program, now
b. ACA section 1557 known as CMS Open Payments.
c. ACA section 6002
Which statement is TRUE regarding compliance a. Compliance programs are considered more dangerous if they are developed
programs? but not implemented.
a. Compliance programs are considered more dangerous
if they are developed but not implemented.
b. Compliance programs can detect but not prevent
criminal conduct
c. Compliance programs are only required by law for
healthcare entities that have more than $500,000 in
annual revenue.
d. Compliance programs are not mandated by law.
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, 5/22/26, 7:06 PM HCCA - CHC Study Questions (MASTER FLASHCARDS) Flashcards | Quizlet
An individual's understanding of the compliance aspects a. annual evaluations
of their job can BEST be enhanced by including
compliance in:
a. annual evaluations
b. exit interviews
c. HR benefit materials
d. audit committee meetings
Formal statement outlining a plan for a specified subject c. Policy document
area. It usually cites state and/or federal required actions
or standards. CAP - outlines corrective action plan
a. CAP Procedure - describes process/steps under a certain criteria
b. Procedure document Legal standards - mandatory action or rule
c. Policy document
d. Legal standards
Life cycle of records management Creation
Use
Maintenance
Retention
Disposition
Standards of Conduct (written P&Ps) Demonstrate the organization's ethical attitude and its "enterprise-wide" emphasis
on compliance with all applicable laws and regulations
Code of Conduct: Content Checklist • Demonstrate system wide emphasis on compliance with all applicable laws and
regulations
• Written plainly and concisely so all employees can understand the standards
• Includes internal and external regulations
• Mentions organizational policies without completely restating them
• Is consistent with company policies and procedures
• Includes management's responsibility to explain and enforce the code
Ref: SCCE Compliance & Ethics Manual, Chapter 2
https://compliancecosmos.org/essential-elements-effective-ethics-and-
compliance-program
Code of Conduct and Employees All employees must receive, read, and understand the standards.
A supervisor should explain the standards and answer any questions.
Employee should attest in writing that they have received, read, and understood
the standards
Employee compliance with standards must be enforced through appropriate
discipline when necessary
Discipline for non-compliance should be stated in the standards
Code of Conduct Purpose • To present specific guidelines for employees to follow
• To confirm that all employees comprehend what is required of them
• To provide a process for proper decision making
• To confirm that employees put standards into everyday practice
• To elevate corporate performance in basic business relationship
• To confirm that the organization upholds and supports proper compliance
conduct
https://quizlet.com/569020649/hcca-chc-study-questions-master-flashcards/ 3/17
HCCA - CHC Study Questions Save Groups
(MASTER FLASHCARDS)
16 studiers today 4.8 (46 reviews)
Students also studied
Flashcard sets Study guides
CHC Practice Test HCCA - CHPC Study Questions (MA... CHC - CCB Practice Test CHC - A
50 terms 302 terms 25 terms 51 terms
ximerestrepo Preview ximerestrepo Preview ximerestrepo Preview xim
Terms in this set (781)
True or False: True
The ACA requires that all providers adopt a compliance
plan as a condition of enrollment with Medicare, ref. ACA section 6102
Medicaid, and Children's Health Insurance Program
(CHIP).
According to HHS-OIG - what are three important 1.Protect our programs
reasons for proper documentation in Compliance? (hint: 2.Protect your patients
protections) 3.Protect the Provider
https://oig.hhs.gov/newsroom/podcasts/2011/heat/heat09-
trans.asp#:~:text=Proper%20documentation%2C%20both%20in%20patients,to%20
protect%20you%20the%20provider.
At which level of the Medicare Part A or Part B appeals c. . third level of appeal
process is the appeal decision by the Office of Medicare
Hearings and Appeals (OMHA)? Frist level - redetermination by Medicare contractor
a. first level of appeal Second level - reconsideration by Independent contractor
b. second level of appeal Third appeal - Administrative Law Judge (ALJ) hearing
c. third level of appeal Fourth appeal - review by Medicare Appeals Council
d. fourth level of appeal 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 a. Leadership skills,
person have?) Choose all that apply. c. Skills to design and implement a compliance program, and
a. Leadership skills. d. Be able to anticipate new risk areas.
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.
https://quizlet.com/569020649/hcca-chc-study-questions-master-flashcards/ 1/17
,5/22/26, 7:06 PM HCCA - CHC Study Questions (MASTER FLASHCARDS) Flashcards | Quizlet
Which of the following is an absolute necessity in order c. non-retaliation for whistleblowers
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
A Compliance Program with well written policies and d. will not be successful without the proper oversight
procedures:
a. can be successful if consistently reviewed and Regardless of having the best written policies in place that are
maintained reviewed/maintained consistently, and read and disseminated accordingly, will fail
b. cannot be effective due to the sheer volume presented if there is no proper oversight to ensure they are actually being followed and
c. will be effective if read by management understood.
d. will not be successful without the proper oversight
A Compliance Officer can achieve a higher level of b. increasing management involvement.
compliance and ethics engagement by:
a. ensuring leadership reads the policies Compliance is everyone's responsibility, but management involvement is crucial.
b. increasing management involvement They have a direct contact with employees, they know and understand their staff's
c. responding to compliance hotline calls needs and concerns, and have the most influence over employee's actions and
d. monitoring the code of conduct 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.
Which of the following requires providers to be c. Balance Budget Act of 1997
permanently excluded from all federal health care
programs if found guilty of a healthcare related fraud a Also known as a BBA "three strikes rule"
third time:
a. Deficit Reduction Act of 2005
b. False Claims Act
c. Balance Budget Act of 1997
d. Social Security Act section 1128d
What section of the ACA prevents discrimination against b. ACA section 1557 is the correct answer.
individuals with limited English proficiency (LEP), and also
prohibits discrimination in healthcare programs and
activities that receive federal funding, based on race, a. ACA section 6102 requires owners, operators, and administrators of LTC facilities
color, national origin, sex, age, or disability. to adopt effective compliance.
a. ACA section 6102 c. ACA section 6002 requires the establishment of a transparency program, now
b. ACA section 1557 known as CMS Open Payments.
c. ACA section 6002
Which statement is TRUE regarding compliance a. Compliance programs are considered more dangerous if they are developed
programs? but not implemented.
a. Compliance programs are considered more dangerous
if they are developed but not implemented.
b. Compliance programs can detect but not prevent
criminal conduct
c. Compliance programs are only required by law for
healthcare entities that have more than $500,000 in
annual revenue.
d. Compliance programs are not mandated by law.
https://quizlet.com/569020649/hcca-chc-study-questions-master-flashcards/ 2/17
, 5/22/26, 7:06 PM HCCA - CHC Study Questions (MASTER FLASHCARDS) Flashcards | Quizlet
An individual's understanding of the compliance aspects a. annual evaluations
of their job can BEST be enhanced by including
compliance in:
a. annual evaluations
b. exit interviews
c. HR benefit materials
d. audit committee meetings
Formal statement outlining a plan for a specified subject c. Policy document
area. It usually cites state and/or federal required actions
or standards. CAP - outlines corrective action plan
a. CAP Procedure - describes process/steps under a certain criteria
b. Procedure document Legal standards - mandatory action or rule
c. Policy document
d. Legal standards
Life cycle of records management Creation
Use
Maintenance
Retention
Disposition
Standards of Conduct (written P&Ps) Demonstrate the organization's ethical attitude and its "enterprise-wide" emphasis
on compliance with all applicable laws and regulations
Code of Conduct: Content Checklist • Demonstrate system wide emphasis on compliance with all applicable laws and
regulations
• Written plainly and concisely so all employees can understand the standards
• Includes internal and external regulations
• Mentions organizational policies without completely restating them
• Is consistent with company policies and procedures
• Includes management's responsibility to explain and enforce the code
Ref: SCCE Compliance & Ethics Manual, Chapter 2
https://compliancecosmos.org/essential-elements-effective-ethics-and-
compliance-program
Code of Conduct and Employees All employees must receive, read, and understand the standards.
A supervisor should explain the standards and answer any questions.
Employee should attest in writing that they have received, read, and understood
the standards
Employee compliance with standards must be enforced through appropriate
discipline when necessary
Discipline for non-compliance should be stated in the standards
Code of Conduct Purpose • To present specific guidelines for employees to follow
• To confirm that all employees comprehend what is required of them
• To provide a process for proper decision making
• To confirm that employees put standards into everyday practice
• To elevate corporate performance in basic business relationship
• To confirm that the organization upholds and supports proper compliance
conduct
https://quizlet.com/569020649/hcca-chc-study-questions-master-flashcards/ 3/17
