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HCCA- CHC EXAM, PRACTICE EXAM AND STUDY
GUIDE NEWEST 2024 ACTUAL EXAM 500+
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH EXPLANATIONS (VERIFIED ANSWERS)
|ALREADY GRADED A+
HCCA- CHC EXAM
What is the term called for an organization's commitment to compliance by the board, management, and employees? It summarizes ethical behavior and legal principles the healthcare organization operates. A) Code of Conduct B) Federal Sentencing Guidelines C) Internal Controls - ANSWER- A) Code of Conduct The U.S. Federal Sentencing Commission was organized in _____, published its initial set of guidelines in _____, and included chapter eight of the Federal Sentencing Guidelines for Organizations (FSGO) in _____. a. 1980, 1987, 1999 b. 1985, 1987, 1991 c. 1980, 1985, 1987 d. 1985, 1990, 2001 - ANSWER- b. 1985, 1987, 1991
"The privacy officer for a hospital has updated the Notice of Privacy Practices to reflect a material change because the previous notice did not have a description that individuals have the right to amend their Protected Health Information. The third party review team identified that the notice did not have the required information to let individuals know of their right to amend PHI. What's the BEST course of action to correct deficiency? A. Make arrangements to have copies of the new NPP mailed to all patients seen within the last year at the hospital B. Make arrangements to have the new notice distributed to new patients that come to the hospital C. Post a copy of the new notice on the hospital's internal intranet so that all employees can see the updated version of the notice D. Meet with legal to discuss how to best self-disclose to the OCR that the hospital was in violation of the NPP requirements and has since - ANSWER- B. Make arrangements to have the new notice distributed to new patients that come to the hospital Remember: The NPP must describe the following individual rights: https://www.law.cornell.edu/cfr/text/45/164.
- The right to request restrictions on uses or disclosures of PHI for treatment, payment or healthcare operations; for use in a facility directory (if applicable); or to family members and others involved in the patient's care; however, the provider is not required to agree to the restriction except in the case of a disclosure to a health insurer if the individual has paid for the care as required by §164.522(a)(1)(vi). This is a change necessitated by the Omnibus Rule.
- The right to receive confidential communications by alternative means or at alternative locations per §164.522(b).
What is the best definition of Medicare/Medicaid abuse? a. Knowingly defrauding the Medicare/Medicaid program b. Intentionally violating Medicare/Medicaid guidelines c. Unknowingly violating Medicare/Medicaid guidelines d. None of the above - ANSWER- c. Unknowingly violating Medicare/Medicaid guidelines FRAUD is intentional (knowingly/willfully); WASTE is overuse/misuse of resources carelessly; ABUSE on the other hand, does not require poof of intent, but it's improper practice leading to unnecessary expenses A provider intentionally upcodes services to a higher level in order to receive a larger reimbursement from Medicare/Medicaid. Is this violation fraud, abuse, or neither? a. Fraud b. Abuse c. Neither - ANSWER- a. Fraud Upcoding - is a type of fraud (knowing/intentionally) coding more expensive codes for higher reimbursement What is true about Medicaid Integrity Programs: a. established by the DRA of 2005 b. federally administered and state monitored
c. audited by MACs d. created to combat Medicare provider FWA - ANSWER- a. established by the DRA of 2005 (section 6034) https://www.ssa.gov/OP_Home/comp2/F109-171.html Notes: b. federally administered and state monitored (the opposite) c. audited by MACs (MIPs are audited by MICs) d. created to combat Medicare provider FWA (Medicaid, not Medicare) Reporting systems should be: a. marketed to contractors b. outsourced to a vendor c. operated by management d. publicized to all employees - ANSWER- d. publicized to all employees Are providers financially liable if their billing services commit fraud without the provider's knowledge? Yes No - ANSWER- Yes - they are financially liable for all claims submitted on their behalf that contain their identification number Regarding patient credit balances, which of the following are good practices for addressing credit balance compliance risks:
c. Persons reporting fraud and abuse who are discharged, demoted, suspended, harassed, or discriminated against have protection from such actions. d. Persons reporting fraud and abuse will be guaranteed another position if they are discharged from their current position. - ANSWER- c. Persons reporting fraud and abuse who are discharged, demoted, suspended, harassed, or discriminated against have protection from such actions. The entity's level of commitment to compliance is directly related to the resources (human and financial) a. True b. False - ANSWER- b. False The code of conduct should address the organization's: a. Culture b. Beliefs c. Ethical position d. All of the above - ANSWER- d. All of the above When developing an effective code of conduct, an organization should consider: a. Soliciting another organization's code and tweaking it to fit b. Methods for reporting issues c. Zero tolerance for fraud and abuse
d. B and C - ANSWER- d. B and C Sue works for ABC Family Physicians. The providers at this office ask her to research the department that helps protect patients from unfair treatment or discrimination. What department or agency would that be? a. Equality in Employment Agency b. Office for Civil Rights c. Department of Justice d. Office of Inspector General - ANSWER- b. Office for Civil Rights (OCR) DOL oversees employment discrimination DOJ enforces federal criminal law and implements criminal law policies OIG combats FWA in Medicare, Medicaid and HHS Programs Note: practice question from AAPC CPCO Ch Which government department is comprised of thousands of employees who enforce the nation's federal criminal laws and help develop and implement criminal law policies? a. Office of Inspector General b. Centers for Medicare & Medicaid Services c. Healthcare Lawyers Association d. Department of Justice - ANSWER- d. Department of Justice OIG combats FWA in Medicare, Medicaid and HHS Programs
Waste - overuse/misuse of resources Note: practice question from AAPC CPCO Ch You are the new compliance officer for a hospital and see that it is currently under an OIG CIA. What would be the first course of action in your new position? a. Review the current OIG Work Plan and update the audit schedule for the hospital. b. Review the Code of Conduct and Policies and Procedures and update them as appropriate. c. Meet with the Compliance Board and discuss your vision of how compliance will be run in the future. d. Review the audit schedule and pick up where the previous compliance officer left off. - ANSWER- b. Review the Code of Conduct and Policies and Procedures and update them as appropriate. 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
Regarding statistical sampling, what is an example of failed efforts to use statistical analysis? a. Users who did not understand subject matter or application of sampling. b. A well-rounded data sample c. Knowledgeable staff who are involved in the process d. Investigations done of improper billing practices - ANSWER- a. Users who did not understand subject matter or application of sampling. The use of qualified personnel and adequate resources is key. Use of experts, when appropriate. True or False: A hospital with an imposed-CIA performs a discovery sample as part of the Claim Review and finds it has a financial error rate above 5%. OIG requires that the hospital then conducts a full sample. - ANSWER- TRUE Probe and Discovery Samples are used to get an initial glimpse and seriousness of a problem to determine if the size of a Full Sample is needed. For example, in Corporate Integrity Agreements (CIA) the OIG requires a Full Sample to be used, if the overpayment error rate, or financial error rate, in a Discovery Sample is at or above 5%. https://oig.hhs.gov/faqs/corporate-integrity-agreements-faq.asp
Does the organization participate in clinical trials (research)? a. Human Resources Director b. Chief of Hospital Operations c. Chief of Compliance d. Medical Staff Services - ANSWER- c. Chief of Compliance These are common questions that help a compliance officer in reviewing some common areas that policies and procedures may need to be addressed. What is RAT STATS? a. Government hotline for fraud and abuse b. Government statistical rules (for example sample size) c. Hospital technology for tracking sampling d. Statistical software for hospitals to use - ANSWER- b. Government statistical rules (for example sample size) The largest and oldest accrediting body for healthcare organizations in the United States, which has accredited more than 22,000 organizations is: a. World Health Organization b. American Medical Association c. The Joint Commission
d. National Committee for Quality Assurance - ANSWER- c. The Joint Commission The Joint Commission is the largest accrediting body/agency. a. World Health Organization - is a goverment agency that leads and champions global efforts to give everyone, everywhere an equal chance to live a healthy life. b. AMA - is a professional association that provides education for physicians and promotes the art and science of medicine and the betterment of public health. d. National Committee for Quality Assurance - is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS®, the performance measurement tool used by more than 90 percent of the nation's health plans. Fill in the blank: The Health ____ _______ Administration (HCFA) encouraged the use of statistical sampling to promote consistency in interpretation and establish FCA liability for claims submitted under Medicare - ANSWER- "Care Financing" See HFCA Ruling No. 86-1 (Feb. 20, 1986). One of the most important foundations of your compliance program is: a. The Compliance Policy Manual b. The Organization Code of Conduct
improve quality of patient care and reduce overall costs What are the benefits to a Compliance Program? - ANSWER- 1. Commitment to Code of Conduct.
- Prevent, detect, and correct unethical behaviors.
- Minimizes financial losses
- Encourages employees to report compliance problems/issues What are the two primary objectives of a Board of Directors (BOD)? - ANSWER- 1. Duty of Care decision making
- Oversight function (BOD can delegate to CEO) What are the two primary focus areas of a Board of Directors (BOD) in compliance? - ANSWER- 1 - structural (need to understand compliance program SOW) 2 - operational (need to understand compliance program needs to operate) What does Duty of Care mean for BOD? - ANSWER- 1. act in good faith
- level of care a prudent person would (avoid negligence)
- protect welfare of organization, act in a manner that's best for all
What are the three roles of a board member? - ANSWER- 1.Compliance oversight. 2.Structuring your compliance program 3.Evaluating effectiveness of the compliance standards and processes. When creating and implementing a compliance plan, the compliance officer should have: A. no approval B. board approval and resolution C. patient approval D. legal approval - ANSWER- B. board approval and resolution What can an effective compliance program do? - ANSWER- Enhance your organizations operations, improve quality of patient care, and reduce overall costs. True or False - A good compliance program will identify problems from time to time, if it doesn't, that's a sign that what you're doing is NOT effective - ANSWER- TRUE What can providers review that will help them understand the compliance requirements of a clinical lab? a. Laboratory Provider Handbook b. OIG's Clinical Lab Guidance
c. Yes, a CLIA number is required if the facility only collects specimens, even if they perform no testing. d. Yes, a Medicare-participating provider that only collects specimens requires a CLIA number. - ANSWER- a. No, a CLIA number is not required if the facility only collects specimens and performs no testing. Note: practice question from AAPC CPCO Ch Which certificate is issued to a laboratory that enables the entity to conduct moderate- to high-complexity laboratory testing until the entity is determined by survey to comply with the CLIA regulations a. Certificate of Compliance b. Certificate for Provider-performed Microscopy procedures c. Certificate of Registration d. Certificate of Waiver - ANSWER- c. Certificate of Registration. Enables the entity to conduct moderate-to high-complexity laboratory testing until the entity is determined by survey to be in compliance with the CLIA regulations. Note: practice question from AAPC CPCO Ch Seven basic elements for a fundamental compliance program as per HCCA CHC exam? - ANSWER- 1. Standards and Written Policies & Procedures
- Compliance Program Admin (CO and Board oversight)
- Effective Education &Training
- Screening and Evaluation (Employees, Physicians, Vendors)
- Communication, Edu & Training
- Auditing & Monitoring, Internal Reporting System
- Discipline for Non-Compliance
- Investigation and Remedial Measures True or False - The OIG requests that you post on your website whether or not the PHRMA CODE is followed - ANSWER- TRUE True or False: Regarding Attorney-Client Privilege, the procedure called "Upjohn warning," in which a company's lawyer explains that the lawyer represents the company and not the individual employee with whom the lawyer is dealing. - ANSWER- TRUE The Upjohn Co. v. United States case (1981), a Supreme Court case that gave rise to the procedure called "Upjohn warning," in which a company's lawyer explains that the lawyer represents the company and not the individual employee with whom the lawyer is dealing. In other words, communications between company counsel and employees of the company are privileged, but the privilege is owned by the company and not the individual employee. The Court made clear that the corporate attorney-client privilege applied to the company.
